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The following is a summary of “Multimodality Therapy Including Pleurectomy/Decortication in Pleural Mesothelioma: Long-Term Outcomes in 152 Consecutive Patients a Retrospective Cohort Study,” published in the February 2025 issue of Surgery by Lang-Lazdunski et al. 

Researchers conducted a retrospective study to investigate the long-term outcomes of pleurectomy decortication, systemic chemotherapy, and prophylactic radiotherapy in pleural mesothelioma (PM).  

They assessed patients treated between October 2004 and October 2019. Patients with PM and favorable prognostic factors, along with completely resectable disease, were selected for trimodality therapy. The treatment protocol included total pleurectomy decortication (P/D), hyperthermic intrapleural povidone-iodine, prophylactic chest wall radiotherapy, and systemic chemotherapy. Disease recurrence was routinely diagnosed using ¹⁸FDG-PET-CT. Further systemic therapies were given when needed. Survival and prognostic factors were analyzed using the Kaplan-Meier method and univariate and multivariate Cox regressions.   

The results showed that 152 patients underwent P/D with curative intent. The median age was 64 years, with a male/female ratio of 123/29. Preoperative chemotherapy was received by 31 patients (20.4%), and 35 patients (23%) underwent extended resections, and 64 patients had Postoperative complications occurred in (42%), but there was no 90-day mortality. Histology was epithelioid in 107 patients (70.4%) and non-epithelioid in 45 (29.6%). Pathological stages were I: 88, II: 0, III: 63, IV: 1 (8th TNM classification) while, 6 patients (4%) did not receive systemic chemotherapy, and 3 (2%) did not receive postoperative radiotherapy. For relapse, 74 patients (48.7%) received further systemic therapies. Median overall survival (OS) was 31.7 months, with 35.0 months for epithelioid and 18.3 months for non-epithelioid histology. Histological type was the only independent predictor of OS in multivariate analysis, regardless of resection status, pathological stage, or lymph node status.  

Investigators concluded that P/D was a safe and well-tolerated procedure linked with prolonged survival, particularly in patients with early-stage epithelioid mesothelioma. 

Source: journals.lww.com/annalsofsurgery/abstract/9900/multimodality_therapy_including.1189.aspx