Malignant diffuse mesothelioma is the most common type of
mesothelioma, with a median survival ranging from 8.5 to 18 months
after diagnosis. Good performance status, absence of chest pain,
age < 50 years, and epithelial histology are all associated with
improved survival. Several investigators have described staging systems
for this tumor and have emphasized the importance of thoracoscopy in
the diagnosis and staging of the disease. Pleurectomy is the most
common surgery employed to manage patients with diffuse mesothelioma,
and this procedure is associated with minimal postoperative morbidity
and mortality. Because mesothelioma usually recurs locally after
surgery, efforts at optimizing local control have included both
intraoperative phototherapy and chemotherapy. However, neither of these
techniques has demonstrated any significant benefit to date and thus
should not be considered as standards of care. No studies have compared
pleurectomy to extrapleural pneumonectomy (EPP) in randomized trials.
However, nonrandomized series suggest a significant improvement in
disease-free survival for those undergoing EPP versus pleurectomy.
Other data suggest that EPP may improve local control but may
predispose the patient to distant metastases. A randomized comparison
of these techniques may be beneficial in identifying the most effective
procedure for patients with malignant diffuse mesothelioma.