Updates in Staging and Management of Malignant Pleural Mesothelioma

Area of Science:

• Thoracic oncology
• Surgical oncology
• Mesothelioma research

Background:

• Malignant pleural mesothelioma (MPM) typically has a poor prognosis without treatment.
• Cancer-directed surgery as part of multimodality treatment can achieve a 15% 5-year survival rate for MPM.
• Key surgical options include extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D).

Purpose of the Study:

• To review the current understanding of MPM staging for surgical patient selection.
• To describe the contemporary literature and practices in MPM surgical management.
• To highlight the role of adjuvant therapies in improving long-term outcomes for MPM.

Main Methods:

• Review of current literature on malignant pleural mesothelioma staging and surgical techniques.
• Analysis of treatment modalities including surgery, chemotherapy, radiotherapy, and immunotherapy.
• Synthesis of evidence regarding patient selection and comparative effectiveness of surgical approaches (EPP vs. P/D).

Main Results:

• Preoperative staging is crucial for selecting appropriate surgical candidates.
• Pleurectomy/decortication (P/D) is generally recommended over extrapleural pneumonectomy (EPP) in most MPM cases.
• Adjuvant therapies, including novel immunotherapy agents, are vital for durable results.

Conclusions:

• Surgical resection, particularly P/D, combined with multimodality treatment, offers improved survival for malignant pleural mesothelioma.
• Accurate staging and judicious patient selection are paramount for optimizing surgical outcomes.
• Ongoing advancements in adjuvant therapies, especially immunotherapy, are critical for enhancing long-term disease control in MPM.