Pleurectomy/decortication in the setting of multimodality treatment for diffuse malignant pleural mesothelioma

Pleurectomy/decortication is a frequently performed operation for patients with diffuse malignant pleural mesothelioma (DMPM). It has a low surgical mortality rate (less than 5%), but is associated with a significant risk of local recurrence. To date, intensive adjuvant radiation or chemotherapy has not diminished that risk. Despite these disappointing results, pleurectomy/decortication may still be the best treatment option for some patients, particularly those with early stage disease whose medical condition precludes pneumonectomy. The role of pleurectomy/decortication in conjunction with newer treatment strategies such as neoadjuvant therapy or gene therapy warrants investigation.