Safety and efficacy of trimodality therapy in patients undergoing extrapleural pneumonectomy

Malignant pleural mesothelioma (MPM) is a rare but rapidly deadly disease (1).Macroscopic complete resection (MCR) is the goal of surgery (2).MCR seems to have the most significant impact on survival in patients undergoing multimodality treatment for MPM.The role of surgical resection in the management of MPM remains controversial.The selection criterion to perform either extrapleural pneumonectomy (EPP) or extended/radical pleurectomy/decortication (PD) rely not only on the cardio-pulmonary status of the patient,tumor stage and intraoperative findings but is strongly dependent also on surgeons' decision and philosophy.This is reflected by a recent survey of opinions and beliefs among 802 thoracic surgeons,in which EPP was believed to be more effective than PD (3).Nonetheless,either surgery might achieve MCR.