[What is the role of pleuropneumonectomy in malignant pleural mesothelioma?].

In this report, the results of conventional pleuropneumonectomy in malignant diffuse mesothelioma are reviewed, and the role of this aggressive surgery in multidisciplinary treatment is discussed. The surgical results may improve owing to recent advances in medical technology, although the postoperative survival time after pleuropneumonectomy has remained nearly the same for the past 40 years. The problems with pleuropneumonectomy are high mortality and morbidity rates, high local recurrence rates, and almost the same survival rates as seen after pleurectomy. The indications for this aggressive surgery are limited to stage I, II, and III disease based on an accurate staging system, with induction therapy for macroscopic radical resection and postoperative chemoradiation therapy. In addition, patients must be monitored for the development of major complications perioperatively. The natural history of this disease should be clarified to determine the effectiveness of various forms of therapy. Precise analysis of the accumulated data from many institutions will help to improve the results of pleuropneumonectomy.