ArticleUpdates in surgery2026
A single-center experience in parenchyma-sparing surgical treatment of malignant pleural mesothelioma.
Article in Updates in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The role of surgery in malignant pleural mesothelioma (MPM) remains controversial, particularly after the negative results of the MARS 1 and 2 trials. Lung-sparing cytoreductive procedures such as extended pleurectomy/decortication (eP/D) are increasingly adopted in high-volume centers, but real-world outcomes within multimodality pathways vary widely. This study analyzes our Institutional experience with parenchyma-sparing surgery in a trimodal strategy, focusing on perioperative outcomes, recurrence patterns, and survival, with particular attention to the prognostic impact of nodal status. We conducted a retrospective observational study including consecutive patients with epithelioid MPM who underwent eP/D with curative intent between 2010 and 2022 at a single tertiary Center. All patients were evaluated within a multidisciplinary framework and routinely received platinum-pemetrexed induction chemotherapy. Clinical, pathological, perioperative, and follow-up data were prospectively recorded. Survival was analyzed using Kaplan-Meier curves and Cox regression. A total of 102 patients were included. Median age was 65.9 years, and 75% were males. Most patients (90%) received induction chemotherapy and 70% completed full trimodality therapy. Median hospital stay was 14 days (IQR 10.3-19.0). Postoperative morbidity occurred in 52% of patients, with major complications in 13%; 30 day and 90 day mortality were 1 and 3%, respectively. Recurrence occurred in 72% of cases, predominantly locoregional. Median disease-free survival (DFS) was 11.7 months (IQR 7.9-18.7) and median overall survival (OS) was 28.0 months (IQR 14.8-48.8). Nodal metastasis was associated with significantly worse OS (34.4 vs 17.4 months, p = 0.004), whereas completion of trimodal therapy did not significantly affect DFS or OS. Lung-sparing cytoreduction within a structured multimodality pathway is safe and achieves survival comparable to major international series. Pathological nodal status represents the strongest prognostic determinant and may guide risk-adapted treatment strategies in the evolving era of multimodal therapy.
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