Department of Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium.
J Thorac Oncol. 2013 May;8(5):525-9. doi: 10.1097/JTO.0b013e31828353d7.
The role of surgery in the management of malignant pleural mesothelioma remains controversial. Surgical resection consists of different procedures for diagnostic or therapeutic reasons. The latter includes either an extrapleural pleuropneumonectomy (EPP) or lung-sparing operations like debulking of the parietal and visceral pleura by pleurectomy/decortication (P/D) or extended pleurectomy/decortication, in which further debulking of the diaphragm or pericardium is included. Because of the modest outcome of surgery as single-modality therapy, combinations of chemotherapy, surgery, and radiation therapy were initiated as a new treatment strategy to improve prognosis. The observations that patients treated with P/D had an equal to better outcome than those treated with EPP, and that EPP with perioperative chemotherapy was better than EPP alone, raises the issue whether performing a P/D with perioperative chemotherapy would result in a further improvement of outcome with a lower operative mortality than with EPP and perioperative chemotherapy. This is the rationale for the next European Organisation for Research and Treatment of Cancer trial exploring the feasibility of P/D with perioperative chemotherapy.
手术在恶性胸膜间皮瘤治疗中的作用仍存在争议。手术切除包括出于诊断或治疗原因的不同程序。后者包括胸膜外全肺切除术 (EPP) 或肺保留手术，如通过胸膜切除术/剥脱术 (P/D) 或扩展胸膜切除术/剥脱术对壁层和脏层胸膜进行减瘤，其中还包括膈肌或心包的进一步减瘤。由于手术作为单一治疗方法的效果有限，因此开始采用化疗、手术和放疗的联合治疗作为改善预后的新治疗策略。观察到接受 P/D 治疗的患者的结果与接受 EPP 治疗的患者相当或更好，并且 EPP 加围手术期化疗优于单独 EPP，这引发了一个问题，即是否进行 P/D 加围手术期化疗会在手术死亡率低于 EPP 和围手术期化疗的情况下进一步改善预后。这就是下一个欧洲癌症研究与治疗组织试验探索围手术期化疗的 P/D 可行性的基本原理。
