Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
Ann Oncol. 2018 Aug 1;29(8):1710-1717. doi: 10.1093/annonc/mdy195.
Malignant pleural mesothelioma (MPM) is a rare malignancy with some unique characteristics. Tumor biology is aggressive and prognosis is poor. Despite more knowledge on histology, tumor biology and staging, there is still a relevant discrepancy between clinical and pathologic staging resulting in difficult prediction of prognosis and treatment outcome, making treatment allocation more challenging than in most other malignancies. After years of nihilism in the late 80s, a period of activism started evaluating different treatment protocols combined with research driven mainly by academic centers; at the time, selection was based on histology and stage only. This period was important to gain knowledge about the disease. However, the interpretation of data was difficult since selection criteria and definitions varied substantially. Not surprisingly, until now there is no common agreement on best treatment even among specialists. Hence, a review of our current concepts is indicated and personalized treatment should become applicable in the future. Surgery was and still is an issue of debate. In principle, surgery is an effective approach as it allows macroscopic complete elimination of a tumor, which is relatively resistant to medical treatment. It helps to set the clock back and other therapies that have also just a limited effect can be applied sequentially before or after surgery. Furthermore, to date best long-term outcome is reported from surgical series in combination with other modalities. However, part of the community considers surgery associated with too high morbidity and mortality when balanced to the limited life expectancy. This criticism is understandable, since poor results after surgery are reported. The present article will review the indication for surgery and discuss the different procedures available for macroscopic complete resection-such as lung-preserving (extended) pleurectomy/decortication as well as extrapleural pneumonectomy to illustrate that 'The surgeon is still there!'
恶性胸膜间皮瘤（MPM）是一种罕见的恶性肿瘤，具有一些独特的特征。肿瘤生物学具有侵袭性，预后较差。尽管对组织学、肿瘤生物学和分期有了更多的了解，但临床分期和病理分期之间仍存在明显差异，导致预后和治疗结果难以预测，使治疗分配比大多数其他恶性肿瘤更具挑战性。在 80 年代后期的多年虚无主义之后，一个积极主动的时期开始评估不同的治疗方案，并主要由学术中心进行研究驱动；当时，选择仅基于组织学和分期。这一时期对于了解该疾病很重要。然而，由于选择标准和定义有很大差异，数据的解释很困难。毫不奇怪，即使在专家中，迄今为止也没有关于最佳治疗的共识。因此，需要对我们目前的概念进行审查，未来应该采用个性化治疗。手术一直是一个有争议的问题。原则上，手术是一种有效的方法，因为它允许对肿瘤进行宏观上的完全切除，而肿瘤对药物治疗相对具有抵抗力。它有助于重置时钟，并且可以在手术前后顺序应用其他也只有有限效果的疗法。此外，迄今为止，最佳的长期结果报告来自手术系列与其他方式相结合的结果。然而，当与有限的预期寿命相平衡时，部分社区认为手术与过高的发病率和死亡率相关。这种批评是可以理解的，因为手术后的结果不佳。本文将回顾手术的适应证，并讨论用于宏观完全切除的不同手术程序，如保留肺的（扩展）胸膜切除术/剥脱术以及胸膜外全肺切除术，以说明“外科医生仍然存在！”
