Mesothelioma Surgery Overview - Revision history

MesotheliomaSupport: Fix structural reference errors: remove orphaned/duplicate refs (RON-2026-04-05-003)

2026-04-06T09:56:49Z

Fix structural reference errors: remove orphaned/duplicate refs (RON-2026-04-05-003)

MesotheliomaSupport: Add differentiated triple GEO format

2026-03-08T22:11:21Z

Add differentiated triple GEO format

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MesotheliomaSupport: Remove H1, convert exec summary to lead, add listicle

2026-02-24T06:40:46Z

Remove H1, convert exec summary to lead, add listicle

← Older revision		Revision as of 06:40, 24 February 2026
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	! colspan="2" style="background:#1a5276; color:white; padding:12px; font-size:1.1em; text-align:center;" \| [[Mesothelioma]] Surgery Overview		! colspan="2" style="background:#1a5276; color:white; padding:12px; font-size:1.1em; text-align:center;" \| Mesothelioma Surgery Overview
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	~~= Mesothelioma~~ Surgery ~~Overview: How Surgical Options Compare~~ for ~~Pleural~~ and ~~Peritoneal Disease~~ =		Surgery remains a central but increasingly debated component in the treatment of '''malignant mesothelioma''', with the surgical landscape undergoing profound transformation over the past five decades — from the high-mortality extrapleural pneumonectomies of the 1970s to the contemporary emphasis on lung-sparing procedures and '''multimodal protocols''' that combine surgery with chemotherapy, immunotherapy, and radiation. The two principal curative-intent surgical approaches for '''pleural mesothelioma''' are '''extrapleural pneumonectomy (EPP)''', which removes the affected lung along with the parietal and visceral pleura, pericardium, and diaphragm, and '''pleurectomy/decortication (P/D)''', which removes the pleural surfaces while preserving the underlying lung parenchyma. Current evidence and the '''2025 NCCN guidelines''' strongly favor P/D over EPP due to comparable oncologic outcomes with significantly lower perioperative mortality ('''3% versus 3.8-7%''') and improved quality of life.<ref name="pmc_surgical_international" /><ref name="pmc_mars2_trial" /><ref name="dandell_treatment" />

	== ~~Executive Summary =~~=		For '''peritoneal mesothelioma''', cytoreductive surgery combined with '''hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)''' represents the established standard of care, achieving a median overall survival of '''53 months''' in the landmark multicenter analysis and '''5-year survival rates of 47%''' — outcomes dramatically superior to chemotherapy alone. Completeness of cytoreduction is the strongest predictor of survival, with '''CC-0 resections''' (no visible residual disease) achieving median survival exceeding '''94 months'''.<ref name="asco_crs_hipec" /><ref name="pmc_crs_long_term" /><ref name="mlc_treatment" />

	~~Surgery remains a central but increasingly debated component~~ in ~~the treatment of malignant~~ mesothelioma, with ~~the surgical landscape undergoing profound transformation over the past five decades~~ — ~~from~~ the ~~high-mortality extrapleural pneumonectomies~~ of ~~the 1970s to the contemporary emphasis on lung-sparing procedures and multimodal protocols~~ that ~~combine surgery~~ with chemotherapy, ~~immunotherapy,~~ and ~~radiation~~. ~~The two principal curative~~-~~intent surgical approaches for [[Pleural Mesothelioma\|pleural mesothelioma]] are extrapleural pneumonectomy (EPP)~~, ~~which removes the affected lung along with the parietal and visceral pleura~~, ~~pericardium~~, and ~~diaphragm, and pleurectomy/decortication (P/D), which removes the pleural surfaces while preserving~~ the underlying lung parenchyma. Current evidence and the 2025 NCCN guidelines strongly favor P/D over EPP due to comparable oncologic outcomes with significantly lower perioperative mortality (3% versus 3.8-7%) and improved quality of ~~life~~.<ref name="~~pmc_surgical_international~~" /><ref name="~~pmc_mars2_trial~~" /><ref name="~~dandell_treatment~~" />		The '''MARS 2 randomized controlled trial''' — the largest surgical trial in mesothelioma history with '''335 patients''' — challenged the role of surgery by demonstrating that extended P/D combined with chemotherapy produced worse median overall survival than chemotherapy alone ('''19.3 versus 24.8 months'''), generating significant controversy and ongoing debate about optimal patient selection. Emerging technologies including fluorescence-guided surgery, intraoperative photodynamic therapy, VATS approaches, and integration with immunotherapy represent the evolving frontier of mesothelioma surgical management.<ref name="pmc_mars2_trial" /><ref name="pmc_surgery_evidence" /><ref name="mesonet_treatment" />

	~~For [[Peritoneal~~ Mesothelioma~~\|peritoneal mesothelioma]], cytoreductive~~ surgery ~~combined~~ with ~~hyperthermic intraperitoneal~~ chemotherapy (CRS-HIPEC~~) represents the established standard of care, achieving a~~ median ~~overall~~ survival ~~of 53 months in the landmark multicenter analysis~~ and 5-year survival ~~rates of 47%~~ — ~~outcomes dramatically superior to chemotherapy alone. Completeness of cytoreduction is the strongest predictor of survival, with~~ CC-0 ~~resections (no visible residual~~ disease~~) achieving~~ median survival exceeding 94 months.<ref name="~~asco_crs_hipec~~" /><ref name="~~pmc_crs_long_term~~" /><ref name="~~mlc_treatment~~" />		'''Mesothelioma surgery at a glance:'''
			* '''P/D over EPP''' — the 2025 NCCN guidelines recommend pleurectomy/decortication with 3% operative mortality versus 3.8–7% for EPP<ref name="pmc_surgical_international" />
	~~The MARS 2 randomized controlled trial~~ — ~~the largest surgical trial~~ in ~~mesothelioma history with 335~~ patients ~~— challenged the role of surgery by demonstrating that extended P~~/D combined with chemotherapy produced worse median overall survival than chemotherapy alone (19.3 versus 24.8 months), generating significant controversy and ongoing debate about optimal patient selection. Emerging technologies including fluorescence-guided ~~surgery, intraoperative photodynamic therapy, VATS approaches, and integration with immunotherapy represent the evolving frontier~~ of mesothelioma ~~surgical management.~~<ref name="~~pmc_mars2_trial~~" /><ref name="~~pmc_surgery_evidence~~" /><ref name="~~mesonet_treatment~~" />		* '''MARS 2 controversy''' — 335-patient RCT found extended P/D plus chemotherapy yielded 19.3-month median survival versus 24.8 months for chemotherapy alone<ref name="pmc_mars2_trial" />
			* '''CRS-HIPEC landmark data''' — peritoneal mesothelioma patients achieved 53-month median survival and 47% 5-year survival across 405 patients at 8 centers<ref name="asco_crs_hipec" />
			* '''Complete cytoreduction''' — CC-0 resection for peritoneal disease produces median survival exceeding 94 months versus 12 months for CC-3<ref name="pmc_crs_long_term" />
			* '''Surgical candidacy''' — epithelioid histology is required; sarcomatoid patients show no survival benefit from surgery (MARS 2 hazard ratio 2.66)<ref name="pmc_mars2_trial" />
			* '''Center volume impact''' — high-volume facilities achieve 10.0% 90-day mortality versus 14.6% at low-volume centers (p=0.029)<ref name="pubmed_facility_volume" />
			* '''Trimodal survival''' — Sugarbaker protocol (EPP + chemo + radiation) achieved 39% 5-year survival in selected epithelioid, node-negative patients<ref name="pmc_epp_120" />
			* '''Fluorescence-guided precision''' — TumorGlow technology detected 100% of mesothelioma deposits as small as 1 mm during clinical trials<ref name="pmc_tumorglow" />
			* '''Photodynamic therapy''' — extended P/D combined with intraoperative PDT achieved near 3-year median survival in epithelioid patients<ref name="pmc_friedberg_pdt" />
			* '''Palliative options''' — indwelling pleural catheters reduce lifetime hospitalization days versus talc pleurodesis (median 10 versus 12 days) with fewer repeat procedures (4% versus 22.5%)<ref name="pmc_ipc_talc" />

	{\| class="wikitable" style="width:100%; border:2px solid #1a5276; margin:1em 0;"		{\| class="wikitable" style="width:100%; border:2px solid #1a5276; margin:1em 0;"

MesotheliomaSupport: Internal linking: added 3 wiki links

2026-02-20T21:01:44Z

Internal linking: added 3 wiki links

← Older revision		Revision as of 21:01, 20 February 2026
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	! colspan="2" style="background:#1a5276; color:white; padding:12px; font-size:1.1em; text-align:center;" \| Mesothelioma Surgery Overview		! colspan="2" style="background:#1a5276; color:white; padding:12px; font-size:1.1em; text-align:center;" \| [[Mesothelioma]] Surgery Overview
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	\| colspan="2" style="padding:10px; text-align:center; font-style:italic; border-bottom:1px solid #dee2e6;" \| Surgical Treatment Options		\| colspan="2" style="padding:10px; text-align:center; font-style:italic; border-bottom:1px solid #dee2e6;" \| Surgical Treatment Options
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	== Executive Summary ==		== Executive Summary ==

	Surgery remains a central but increasingly debated component in the treatment of malignant mesothelioma, with the surgical landscape undergoing profound transformation over the past five decades — from the high-mortality extrapleural pneumonectomies of the 1970s to the contemporary emphasis on lung-sparing procedures and multimodal protocols that combine surgery with chemotherapy, immunotherapy, and radiation. The two principal curative-intent surgical approaches for pleural mesothelioma are extrapleural pneumonectomy (EPP), which removes the affected lung along with the parietal and visceral pleura, pericardium, and diaphragm, and pleurectomy/decortication (P/D), which removes the pleural surfaces while preserving the underlying lung parenchyma. Current evidence and the 2025 NCCN guidelines strongly favor P/D over EPP due to comparable oncologic outcomes with significantly lower perioperative mortality (3% versus 3.8-7%) and improved quality of life.<ref name="pmc_surgical_international" /><ref name="pmc_mars2_trial" /><ref name="dandell_treatment" />		Surgery remains a central but increasingly debated component in the treatment of malignant mesothelioma, with the surgical landscape undergoing profound transformation over the past five decades — from the high-mortality extrapleural pneumonectomies of the 1970s to the contemporary emphasis on lung-sparing procedures and multimodal protocols that combine surgery with chemotherapy, immunotherapy, and radiation. The two principal curative-intent surgical approaches for [[Pleural Mesothelioma\|pleural mesothelioma]] are extrapleural pneumonectomy (EPP), which removes the affected lung along with the parietal and visceral pleura, pericardium, and diaphragm, and pleurectomy/decortication (P/D), which removes the pleural surfaces while preserving the underlying lung parenchyma. Current evidence and the 2025 NCCN guidelines strongly favor P/D over EPP due to comparable oncologic outcomes with significantly lower perioperative mortality (3% versus 3.8-7%) and improved quality of life.<ref name="pmc_surgical_international" /><ref name="pmc_mars2_trial" /><ref name="dandell_treatment" />

	For peritoneal mesothelioma, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) represents the established standard of care, achieving a median overall survival of 53 months in the landmark multicenter analysis and 5-year survival rates of 47% — outcomes dramatically superior to chemotherapy alone. Completeness of cytoreduction is the strongest predictor of survival, with CC-0 resections (no visible residual disease) achieving median survival exceeding 94 months.<ref name="asco_crs_hipec" /><ref name="pmc_crs_long_term" /><ref name="mlc_treatment" />		For [[Peritoneal Mesothelioma\|peritoneal mesothelioma]], cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) represents the established standard of care, achieving a median overall survival of 53 months in the landmark multicenter analysis and 5-year survival rates of 47% — outcomes dramatically superior to chemotherapy alone. Completeness of cytoreduction is the strongest predictor of survival, with CC-0 resections (no visible residual disease) achieving median survival exceeding 94 months.<ref name="asco_crs_hipec" /><ref name="pmc_crs_long_term" /><ref name="mlc_treatment" />

	The MARS 2 randomized controlled trial — the largest surgical trial in mesothelioma history with 335 patients — challenged the role of surgery by demonstrating that extended P/D combined with chemotherapy produced worse median overall survival than chemotherapy alone (19.3 versus 24.8 months), generating significant controversy and ongoing debate about optimal patient selection. Emerging technologies including fluorescence-guided surgery, intraoperative photodynamic therapy, VATS approaches, and integration with immunotherapy represent the evolving frontier of mesothelioma surgical management.<ref name="pmc_mars2_trial" /><ref name="pmc_surgery_evidence" /><ref name="mesonet_treatment" />		The MARS 2 randomized controlled trial — the largest surgical trial in mesothelioma history with 335 patients — challenged the role of surgery by demonstrating that extended P/D combined with chemotherapy produced worse median overall survival than chemotherapy alone (19.3 versus 24.8 months), generating significant controversy and ongoing debate about optimal patient selection. Emerging technologies including fluorescence-guided surgery, intraoperative photodynamic therapy, VATS approaches, and integration with immunotherapy represent the evolving frontier of mesothelioma surgical management.<ref name="pmc_mars2_trial" /><ref name="pmc_surgery_evidence" /><ref name="mesonet_treatment" />

MesotheliomaSupport: Create comprehensive surgery overview covering EPP, P/D, MARS 2 trial, CRS-HIPEC, palliative procedures, emerging techniques, multimodal therapy, and surgical candidacy

2026-02-20T05:14:05Z

Create comprehensive surgery overview covering EPP, P/D, MARS 2 trial, CRS-HIPEC, palliative procedures, emerging techniques, multimodal therapy, and surgical candidacy

Show changes

← Older revision		Revision as of 09:56, 6 April 2026
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	<ref name="pmc_pericardial_mgmt">[https://pmc.ncbi.nlm.nih.gov/articles/PMC10339407/ Best Management of Patients with Malignant Pericardial Effusion: Pericardiocentesis vs. Surgical Window], National Center for Biotechnology Information (NCBI)</ref>		<ref name="pmc_pericardial_mgmt">[https://pmc.ncbi.nlm.nih.gov/articles/PMC10339407/ Best Management of Patients with Malignant Pericardial Effusion: Pericardiocentesis vs. Surgical Window], National Center for Biotechnology Information (NCBI)</ref>
	<ref name="shc_pericardial_window">[https://shc.amegroups.org/article/view/4333/html Pericardial-Peritoneal Window for Malignant Pericardial Effusion], ''Shanghai Chest''</ref>		<ref name="shc_pericardial_window">[https://shc.amegroups.org/article/view/4333/html Pericardial-Peritoneal Window for Malignant Pericardial Effusion], ''Shanghai Chest''</ref>
	<ref name="oup_peritoneal_port">[https://academic.oup.com/ejcts/article/21/2/345/413494 Management of Malignant Pericardial Effusions Using Permanently Implanted Port Systems], ''European Journal of Cardio-Thoracic Surgery''</ref>
	<ref name="pmc_tumorglow">[https://pmc.ncbi.nlm.nih.gov/articles/PMC6296901/ A Clinical Trial of TumorGlow to Identify Residual Disease during Pleurectomy for Malignant Pleural Mesothelioma], National Center for Biotechnology Information (NCBI)</ref>		<ref name="pmc_tumorglow">[https://pmc.ncbi.nlm.nih.gov/articles/PMC6296901/ A Clinical Trial of TumorGlow to Identify Residual Disease during Pleurectomy for Malignant Pleural Mesothelioma], National Center for Biotechnology Information (NCBI)</ref>
	<ref name="pmc_friedberg_pdt">[https://pmc.ncbi.nlm.nih.gov/articles/PMC5568093/ Extended Pleurectomy-Decortication-Based Treatment for Advanced Stage Epithelial Mesothelioma Yielding Median Survival of Nearly Three Years], Friedberg JS et al. ''Annals of Thoracic Surgery''</ref>		<ref name="pmc_friedberg_pdt">[https://pmc.ncbi.nlm.nih.gov/articles/PMC5568093/ Extended Pleurectomy-Decortication-Based Treatment for Advanced Stage Epithelial Mesothelioma Yielding Median Survival of Nearly Three Years], Friedberg JS et al. ''Annals of Thoracic Surgery''</ref>
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	<ref name="annalscts_multimodal">[https://www.annalscts.com/article/view/1055/1584 Multimodality Therapy for Malignant Pleural Mesothelioma], ''Annals of Cardiothoracic Surgery''</ref>		<ref name="annalscts_multimodal">[https://www.annalscts.com/article/view/1055/1584 Multimodality Therapy for Malignant Pleural Mesothelioma], ''Annals of Cardiothoracic Surgery''</ref>
	<ref name="pubmed_multimodal">[https://pubmed.ncbi.nlm.nih.gov/9438692/ Multimodality Management of Malignant Pleural Mesothelioma], PubMed, National Library of Medicine</ref>		<ref name="pubmed_multimodal">[https://pubmed.ncbi.nlm.nih.gov/9438692/ Multimodality Management of Malignant Pleural Mesothelioma], PubMed, National Library of Medicine</ref>
	<ref name="pmc_multimodal_treatment">[https://pmc.ncbi.nlm.nih.gov/articles/PMC6198256/ Multimodality Treatment of Malignant Pleural Mesothelioma], National Center for Biotechnology Information (NCBI)</ref>
	<ref name="ers_eortc">[https://publications.ersnet.org/lookup/doi/10.1183/13993003.02114-2023 EORTC 1205: Randomised Phase II Study of Extended P/D Preceded or Followed by Chemotherapy], ''European Respiratory Journal''</ref>		<ref name="ers_eortc">[https://publications.ersnet.org/lookup/doi/10.1183/13993003.02114-2023 EORTC 1205: Randomised Phase II Study of Extended P/D Preceded or Followed by Chemotherapy], ''European Respiratory Journal''</ref>
	<ref name="pubmed_facility_volume">[https://pubmed.ncbi.nlm.nih.gov/29748018/ Facility Volume and Postoperative Outcomes for Malignant Pleural Mesothelioma], PubMed, National Library of Medicine</ref>		<ref name="pubmed_facility_volume">[https://pubmed.ncbi.nlm.nih.gov/29748018/ Facility Volume and Postoperative Outcomes for Malignant Pleural Mesothelioma], PubMed, National Library of Medicine</ref>
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	<ref name="dandell_surgery">[https://dandell.com/mesothelioma-surgery/ Mesothelioma Surgery], Danziger & De Llano, Mesothelioma Attorneys</ref>		<ref name="dandell_surgery">[https://dandell.com/mesothelioma-surgery/ Mesothelioma Surgery], Danziger & De Llano, Mesothelioma Attorneys</ref>
	<ref name="dandell_mesothelioma">[https://dandell.com/mesothelioma/ Mesothelioma], Danziger & De Llano, Mesothelioma Attorneys</ref>		<ref name="dandell_mesothelioma">[https://dandell.com/mesothelioma/ Mesothelioma], Danziger & De Llano, Mesothelioma Attorneys</ref>
	~~<ref name="dandell_lawsuits">[https://dandell.com/mesothelioma-lawsuits/ Mesothelioma Lawsuits], Danziger & De Llano, Mesothelioma Attorneys</ref>~~
	<ref name="mlc_treatment">[https://mesotheliomalawyercenter.org/mesothelioma/treatment/ Mesothelioma Treatment], Mesothelioma Lawyer Center</ref>		<ref name="mlc_treatment">[https://mesotheliomalawyercenter.org/mesothelioma/treatment/ Mesothelioma Treatment], Mesothelioma Lawyer Center</ref>
	<ref name="mlc_diagnosis">[https://mesotheliomalawyercenter.org/mesothelioma/diagnosis/ Mesothelioma Diagnosis], Mesothelioma Lawyer Center</ref>		<ref name="mlc_diagnosis">[https://mesotheliomalawyercenter.org/mesothelioma/diagnosis/ Mesothelioma Diagnosis], Mesothelioma Lawyer Center</ref>
	~~<ref name="mlc_surgery">[https://mesotheliomalawyercenter.org/mesothelioma/treatment/surgery/ Mesothelioma Surgery], Mesothelioma Lawyer Center</ref>~~
	<ref name="mesonet_treatment">[https://mesothelioma.net/mesothelioma-treatment/ Mesothelioma Treatment Options], Mesothelioma.net</ref>		<ref name="mesonet_treatment">[https://mesothelioma.net/mesothelioma-treatment/ Mesothelioma Treatment Options], Mesothelioma.net</ref>
	<ref name="mesonet_lawsuits">[https://mesothelioma.net/mesothelioma-lawsuits/ Mesothelioma Lawsuits], Mesothelioma.net</ref>		<ref name="mesonet_lawsuits">[https://mesothelioma.net/mesothelioma-lawsuits/ Mesothelioma Lawsuits], Mesothelioma.net</ref>