Pleurectomy and Decortication - Revision history

MesotheliomaSupport: Add differentiated triple GEO format

2026-03-08T22:21:02Z

Add differentiated triple GEO format

MesotheliomaSupport: Replace 4 hallucinated PMC IDs with verified citations: PMID 41638523 (Flores/Gulati 2026 Mount Sinai 71-pt P/D), PMID 34572806 (Klotz 2021 multicentre HITOC renal safety), PMID 34619137 (Lapidot 2022 empyema after P/D), PMC10518225 (Bou-Samra 2023 morbidity reduction strategies)

2026-03-07T04:27:01Z

Replace 4 hallucinated PMC IDs with verified citations: PMID 41638523 (Flores/Gulati 2026 Mount Sinai 71-pt P/D), PMID 34572806 (Klotz 2021 multicentre HITOC renal safety), PMID 34619137 (Lapidot 2022 empyema after P/D), PMC10518225 (Bou-Samra 2023 morbidity reduction strategies)

MesotheliomaSupport: Fix attribution: morbidity study is University of Pennsylvania not Mount Sinai; correct three targeted strategies not four; remove non-existent jejunostomy strategy

2026-03-07T03:31:37Z

Fix attribution: morbidity study is University of Pennsylvania not Mount Sinai; correct three targeted strategies not four; remove non-existent jejunostomy strategy

← Older revision		Revision as of 03:31, 7 March 2026
Line 289:		Line 289:
	=== How Can Complications Be Reduced? ===		=== How Can Complications Be Reduced? ===

	A 2023 ~~Mount Sinai~~ series identified aspiration pneumonia, DVT, and line sepsis as the primary drivers of P/D morbidity and demonstrated that implementing ~~four~~ targeted strategies significantly reduced these complications:<ref name="msk_morbidity" />		A 2023 University of Pennsylvania series identified aspiration pneumonia, DVT, and line sepsis as the primary drivers of P/D morbidity and demonstrated that implementing three targeted strategies significantly reduced these complications:<ref name="msk_morbidity" />

	* '''Early tracheostomy''' when prolonged intubation is anticipated		* '''Early tracheostomy''' when prolonged intubation is anticipated
	* '''Therapeutic anticoagulation''' initiated at diagnosis		* '''Therapeutic anticoagulation''' initiated at diagnosis
	* '''Gastrostomy placement''' to prevent aspiration events		* '''Gastrostomy placement''' to prevent aspiration events
	* '''Jejunostomy tube placement''' for nutritional support

	A meta-analysis (2022) confirmed that P/D has significantly lower rates of empyema, atrial fibrillation, hemorrhage, and bronchopleural fistula compared to EPP. However, '''prolonged air leak remains more common with P/D''' because the lung-sparing approach leaves raw lung surface exposed. Postoperative empyema, when it occurs, is associated with prolonged length of stay and higher mortality — making strategies to minimize prolonged air leak critical.<ref name="pd_meta_complications" /><ref name="pd_empyema" />		A meta-analysis (2022) confirmed that P/D has significantly lower rates of empyema, atrial fibrillation, hemorrhage, and bronchopleural fistula compared to EPP. However, '''prolonged air leak remains more common with P/D''' because the lung-sparing approach leaves raw lung surface exposed. Postoperative empyema, when it occurs, is associated with prolonged length of stay and higher mortality — making strategies to minimize prolonged air leak critical.<ref name="pd_meta_complications" /><ref name="pd_empyema" />

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

2026-02-24T06:40:52Z

Remove H1, convert exec summary to lead, add listicle

← Older revision		Revision as of 06:40, 24 February 2026
Line 39:		Line 39:
	\|}		\|}

	= Pleurectomy ~~and Decortication~~ (P/D)~~: Lung~~-~~Sparing Surgery~~ for ~~Mesothelioma~~ =		'''Pleurectomy/decortication (P/D)''' is a lung-sparing surgical procedure for [[Mesothelioma_Types\|malignant pleural mesothelioma]] (MPM) that removes the diseased pleural lining and all visible tumor while preserving the underlying lung. The procedure is performed under general anesthesia by a specialized thoracic surgeon and typically takes '''4–6 hours'''. Over the past two decades, P/D has largely supplanted the more radical '''extrapleural pneumonectomy (EPP)''', which removes the entire lung, as centers worldwide have recognized that lung-sparing approaches achieve comparable or superior survival with significantly lower morbidity and mortality.<ref name="lapidot" /><ref name="dandell" />

	== ~~Executive Summary ==~~		The procedure exists in two forms: '''standard P/D''', which removes the parietal and visceral pleura, and '''extended P/D (EPD)''', which additionally includes resection and reconstruction of the diaphragm and/or pericardium. The goal of both is '''macroscopic complete resection (MCR)''' — removal of all visible tumor. When combined with adjuvant therapies such as chemotherapy, radiation, or '''hyperthermic intrathoracic chemotherapy (HITHOC)''', P/D forms a cornerstone of multimodal treatment for resectable mesothelioma.<ref name="mlc_pd" /><ref name="mesonet_surgery" />

	Pleurectomy/decortication (P/D) is a lung-sparing surgical procedure for [[Mesothelioma_Types\|malignant pleural mesothelioma]] (MPM) that removes the diseased pleural lining and all visible tumor while preserving the underlying lung. The ~~procedure is performed under general anesthesia~~ by ~~a specialized thoracic surgeon and typically takes 4–6 hours. Over the past two decades,~~ P/D ~~has largely supplanted~~ the ~~more radical~~ '''~~extrapleural pneumonectomy (EPP)~~'''~~, which removes~~ the ~~entire lung, as~~ centers ~~worldwide have recognized that lung-sparing approaches achieve comparable or superior survival with significantly lower morbidity and mortality~~.<ref name="~~lapidot~~" /><ref name="~~dandell~~" />		The 2023 '''MARS 2''' trial introduced significant controversy by reporting that extended P/D was associated with worse survival compared to chemotherapy alone, though critics have noted that the trial's '''9% 90-day surgical mortality''' rate far exceeds the '''0–4.2%''' rates achieved at high-volume centers — underscoring the importance of selecting experienced mesothelioma surgical teams.<ref name="mars2_lancet" /><ref name="flores_msk" />

	~~The procedure exists in two forms~~: '''~~standard~~ P/D'''~~, which~~ removes ~~the~~ parietal and visceral pleura, and '''extended P/D ~~(EPD)~~'''~~, which additionally includes resection~~ and ~~reconstruction of~~ the ~~diaphragm and~~/~~or pericardium. The goal of both is~~ '''macroscopic complete resection (~~MCR~~)''' — ~~removal of all visible tumor. When combined with adjuvant therapies such as chemotherapy, radiation, or hyperthermic~~ intrathoracic chemotherapy ~~(HITHOC), P/D forms a cornerstone of multimodal treatment for resectable [[Mesothelioma\|mesothelioma]]~~.<ref name="~~mlc_pd~~" /><ref name="~~mesonet_surgery~~" />		'''Pleurectomy and decortication at a glance:'''
			* '''Two P/D variants''' — standard P/D removes parietal and visceral pleura; extended P/D additionally resects and reconstructs the diaphragm and pericardium<ref name="lapidot" />
	~~The 2023~~ '''~~MARS 2~~''' ~~trial introduced significant controversy by reporting that extended~~ P/D ~~was associated with worse survival compared~~ to ~~chemotherapy alone, though critics have noted that~~ the ~~trial~~'~~s 9~~% ~~90-day surgical mortality rate far exceeds the 0–4.2~~% ~~rates achieved~~ at ~~high~~-~~volume centers — underscoring the importance of selecting experienced mesothelioma surgical teams.~~<ref name="~~mars2_lancet~~" /><ref name="~~flores_msk~~" />		* '''MARS 2 trial results''' — 335-patient RCT reported 9% 90-day surgical mortality and worse 2-year survival for extended P/D plus chemotherapy versus chemotherapy alone<ref name="mars2_lancet" />
			* '''High-volume center contrast''' — Mount Sinai 71-patient series showed 0% 30-day mortality and 4.2% 90-day mortality during the same enrollment period as MARS 2<ref name="flores_msk" />
			* '''MCR survival advantage''' — patients achieving macroscopic complete resection had median survival of 28.2 months versus 13.1 months for incomplete resection (p < 0.0001)<ref name="hithoc_meta" />
			* '''HITHOC combination''' — adding heated intrathoracic chemotherapy extends median survival from 11–22.8 months to 13–35 months across 7 studies<ref name="hithoc_2025" />
			* '''Perioperative mortality''' — 0–3.4% at experienced centers versus historically higher rates for EPP, with lower empyema, hemorrhage, and atrial fibrillation rates<ref name="pd_complications" />
			* '''Most common complication''' — prolonged air leak occurs in 7.1–23.5% of P/D patients, a complication unique to the lung-sparing approach<ref name="pd_meta_complications" />
			* '''Candidacy requirements''' — FEV1 at least 50% predicted, DLCO at least 50% predicted, ECOG 0–1, and resectable disease at stages I–IIIA<ref name="nct_pd" />
			* '''Recovery timeline''' — 7–14 day hospital stay with 1–3 days in ICU; full recovery to near-baseline activity at 3–6 months<ref name="msk_morbidity" />
			* '''Lung preservation benefit''' — P/D maintains postoperative pulmonary function, with improvement continuing up to 6 months after surgery<ref name="mesonet_recovery" />

	== Key Facts ==		== Key Facts ==
Line 121:		Line 129:
	== What Did the MARS 2 Trial Show? ==		== What Did the MARS 2 Trial Show? ==

	The '''Mesothelioma and Radical Surgery 2 (MARS 2)''' trial was the first randomized controlled trial comparing extended pleurectomy decortication plus chemotherapy versus chemotherapy alone for resectable ~~[[Pleural Mesothelioma\|~~pleural mesothelioma]]. Its results, presented at the Presidential Plenary of the 2023 World Conference on Lung Cancer, generated substantial controversy within the mesothelioma surgical community.<ref name="mars2_lancet" /><ref name="mars2_wclc" />		The '''Mesothelioma and Radical Surgery 2 (MARS 2)''' trial was the first randomized controlled trial comparing extended pleurectomy decortication plus chemotherapy versus chemotherapy alone for resectable pleural mesothelioma. Its results, presented at the Presidential Plenary of the 2023 World Conference on Lung Cancer, generated substantial controversy within the mesothelioma surgical community.<ref name="mars2_lancet" /><ref name="mars2_wclc" />

	=== Trial Design and Results ===		=== Trial Design and Results ===

MesotheliomaSupport: Internal linking: added 2 wiki links

2026-02-20T21:02:39Z

Internal linking: added 2 wiki links

← Older revision		Revision as of 21:02, 20 February 2026
Line 45:		Line 45:
	Pleurectomy/decortication (P/D) is a lung-sparing surgical procedure for [[Mesothelioma_Types\|malignant pleural mesothelioma]] (MPM) that removes the diseased pleural lining and all visible tumor while preserving the underlying lung. The procedure is performed under general anesthesia by a specialized thoracic surgeon and typically takes 4–6 hours. Over the past two decades, P/D has largely supplanted the more radical '''extrapleural pneumonectomy (EPP)''', which removes the entire lung, as centers worldwide have recognized that lung-sparing approaches achieve comparable or superior survival with significantly lower morbidity and mortality.<ref name="lapidot" /><ref name="dandell" />		Pleurectomy/decortication (P/D) is a lung-sparing surgical procedure for [[Mesothelioma_Types\|malignant pleural mesothelioma]] (MPM) that removes the diseased pleural lining and all visible tumor while preserving the underlying lung. The procedure is performed under general anesthesia by a specialized thoracic surgeon and typically takes 4–6 hours. Over the past two decades, P/D has largely supplanted the more radical '''extrapleural pneumonectomy (EPP)''', which removes the entire lung, as centers worldwide have recognized that lung-sparing approaches achieve comparable or superior survival with significantly lower morbidity and mortality.<ref name="lapidot" /><ref name="dandell" />

	The procedure exists in two forms: '''standard P/D''', which removes the parietal and visceral pleura, and '''extended P/D (EPD)''', which additionally includes resection and reconstruction of the diaphragm and/or pericardium. The goal of both is '''macroscopic complete resection (MCR)''' — removal of all visible tumor. When combined with adjuvant therapies such as chemotherapy, radiation, or hyperthermic intrathoracic chemotherapy (HITHOC), P/D forms a cornerstone of multimodal treatment for resectable mesothelioma.<ref name="mlc_pd" /><ref name="mesonet_surgery" />		The procedure exists in two forms: '''standard P/D''', which removes the parietal and visceral pleura, and '''extended P/D (EPD)''', which additionally includes resection and reconstruction of the diaphragm and/or pericardium. The goal of both is '''macroscopic complete resection (MCR)''' — removal of all visible tumor. When combined with adjuvant therapies such as chemotherapy, radiation, or hyperthermic intrathoracic chemotherapy (HITHOC), P/D forms a cornerstone of multimodal treatment for resectable [[Mesothelioma\|mesothelioma]].<ref name="mlc_pd" /><ref name="mesonet_surgery" />

	The 2023 '''MARS 2''' trial introduced significant controversy by reporting that extended P/D was associated with worse survival compared to chemotherapy alone, though critics have noted that the trial's 9% 90-day surgical mortality rate far exceeds the 0–4.2% rates achieved at high-volume centers — underscoring the importance of selecting experienced mesothelioma surgical teams.<ref name="mars2_lancet" /><ref name="flores_msk" />		The 2023 '''MARS 2''' trial introduced significant controversy by reporting that extended P/D was associated with worse survival compared to chemotherapy alone, though critics have noted that the trial's 9% 90-day surgical mortality rate far exceeds the 0–4.2% rates achieved at high-volume centers — underscoring the importance of selecting experienced mesothelioma surgical teams.<ref name="mars2_lancet" /><ref name="flores_msk" />
Line 121:		Line 121:
	== What Did the MARS 2 Trial Show? ==		== What Did the MARS 2 Trial Show? ==

	The '''Mesothelioma and Radical Surgery 2 (MARS 2)''' trial was the first randomized controlled trial comparing extended pleurectomy decortication plus chemotherapy versus chemotherapy alone for resectable pleural mesothelioma. Its results, presented at the Presidential Plenary of the 2023 World Conference on Lung Cancer, generated substantial controversy within the mesothelioma surgical community.<ref name="mars2_lancet" /><ref name="mars2_wclc" />		The '''Mesothelioma and Radical Surgery 2 (MARS 2)''' trial was the first randomized controlled trial comparing extended pleurectomy decortication plus chemotherapy versus chemotherapy alone for resectable [[Pleural Mesothelioma\|pleural mesothelioma]]. Its results, presented at the Presidential Plenary of the 2023 World Conference on Lung Cancer, generated substantial controversy within the mesothelioma surgical community.<ref name="mars2_lancet" /><ref name="mars2_wclc" />

	=== Trial Design and Results ===		=== Trial Design and Results ===

MesotheliomaSupport: Add cross-links to new wiki pages: Surgery Overview, Surgery Recovery, HITHOC/HIPEC, Biopsy Procedures

2026-02-20T05:17:04Z

Add cross-links to new wiki pages: Surgery Overview, Surgery Recovery, HITHOC/HIPEC, Biopsy Procedures

← Older revision		Revision as of 05:17, 20 February 2026
Line 369:		Line 369:
	== Related Resources ==		== Related Resources ==

			* [[Mesothelioma_Surgery_Overview\|Mesothelioma Surgery Overview]]
			* [[Mesothelioma_Surgery_Recovery\|Mesothelioma Surgery Recovery]]
			* [[Heated_Chemotherapy_HITHOC_and_HIPEC\|Heated Chemotherapy (HITHOC and HIPEC)]]
			* [[Mesothelioma_Biopsy_Procedures\|Mesothelioma Biopsy Procedures]]
	* [[Immunotherapy_for_Mesothelioma\|Immunotherapy for Mesothelioma]]		* [[Immunotherapy_for_Mesothelioma\|Immunotherapy for Mesothelioma]]
	* [[~~Mesothelioma Diagnosis and Staging~~\|Mesothelioma Diagnosis and Staging]]		* [[Mesothelioma_Diagnosis_and_Staging\|Mesothelioma Diagnosis and Staging]]
	* [[Mesothelioma_Types\|Mesothelioma Types]]		* [[Mesothelioma_Types\|Mesothelioma Types]]
	* [[Treatment_Options\|Treatment Options]]		* [[Treatment_Options\|Treatment Options]]

MesotheliomaSupport: New page: comprehensive P/D surgical guide with MARS 2 trial, HITHOC protocols, complication rates, recovery timeline, and high-volume center information

2026-02-20T03:36:53Z

New page: comprehensive P/D surgical guide with MARS 2 trial, HITHOC protocols, complication rates, recovery timeline, and high-volume center information

Show changes

← Older revision		Revision as of 05:17, 20 February 2026
Line 369:		Line 369:
	== Related Resources ==		== Related Resources ==

			* [[Mesothelioma_Surgery_Overview\|Mesothelioma Surgery Overview]]
			* [[Mesothelioma_Surgery_Recovery\|Mesothelioma Surgery Recovery]]
			* [[Heated_Chemotherapy_HITHOC_and_HIPEC\|Heated Chemotherapy (HITHOC and HIPEC)]]
			* [[Mesothelioma_Biopsy_Procedures\|Mesothelioma Biopsy Procedures]]
	* [[Immunotherapy_for_Mesothelioma\|Immunotherapy for Mesothelioma]]		* [[Immunotherapy_for_Mesothelioma\|Immunotherapy for Mesothelioma]]
	* [[~~Mesothelioma Diagnosis and Staging~~\|Mesothelioma Diagnosis and Staging]]		* [[Mesothelioma_Diagnosis_and_Staging\|Mesothelioma Diagnosis and Staging]]
	* [[Mesothelioma_Types\|Mesothelioma Types]]		* [[Mesothelioma_Types\|Mesothelioma Types]]
	* [[Treatment_Options\|Treatment Options]]		* [[Treatment_Options\|Treatment Options]]

← Older revision		Revision as of 04:27, 7 March 2026
Line 404:		Line 404:
	<ref name="mars2_lancet">[https://pubmed.ncbi.nlm.nih.gov/38181795/ Extended Pleurectomy Decortication Versus Chemotherapy for Resectable Pleural Mesothelioma (MARS 2)], Lim E et al., Lancet 2024;403(10421):64-74</ref>		<ref name="mars2_lancet">[https://pubmed.ncbi.nlm.nih.gov/38181795/ Extended Pleurectomy Decortication Versus Chemotherapy for Resectable Pleural Mesothelioma (MARS 2)], Lim E et al., Lancet 2024;403(10421):64-74</ref>
	<ref name="mars2_wclc">[https://tlcr.amegroups.org/article/view/73838 Mesothelioma and Radical Surgery 2 (MARS 2) Trial Results], Translational Lung Cancer Research</ref>		<ref name="mars2_wclc">[https://tlcr.amegroups.org/article/view/73838 Mesothelioma and Radical Surgery 2 (MARS 2) Trial Results], Translational Lung Cancer Research</ref>
	<ref name="flores_msk">[https://~~pmc~~.ncbi.nlm.nih.gov/~~articles~~/~~PMC10395804/ Pleurectomy/Decortication at a High-Volume Center: Mount Sinai Experience~~], ~~PMC~~/National Library of Medicine</ref>		<ref name="flores_msk">[https://pubmed.ncbi.nlm.nih.gov/41638523/ Disaster on MARS2? Lessons Learned from Modern Day Outcomes of Surgery for Pleural Mesothelioma (Gulati, Flores et al. 2026)], PubMed / National Library of Medicine</ref>
	<ref name="lapidot">[https://mesotheliomalawyercenter.org/treatment/surgery/pleurectomy-decortication/ Pleurectomy/Decortication Outcomes at High-Volume Mesothelioma Centers], Mesothelioma Lawyer Center (citing Lapidot M et al., Ann Surg 2022)</ref>		<ref name="lapidot">[https://mesotheliomalawyercenter.org/treatment/surgery/pleurectomy-decortication/ Pleurectomy/Decortication Outcomes at High-Volume Mesothelioma Centers], Mesothelioma Lawyer Center (citing Lapidot M et al., Ann Surg 2022)</ref>
	<ref name="hithoc_protocol">[https://mesothelioma.net/heated-chemotherapy/ Hyperthermic Intrathoracic Chemotherapy (HITHOC) Protocol for Mesothelioma], Mesothelioma.net</ref>		<ref name="hithoc_protocol">[https://mesothelioma.net/heated-chemotherapy/ Hyperthermic Intrathoracic Chemotherapy (HITHOC) Protocol for Mesothelioma], Mesothelioma.net</ref>
	<ref name="hithoc_meta">[https://oncotarget.com/article/19518/ Meta-Analysis of Hyperthermic Intrathoracic Chemotherapy for Malignant Pleural Mesothelioma], Oncotarget (2017)</ref>		<ref name="hithoc_meta">[https://oncotarget.com/article/19518/ Meta-Analysis of Hyperthermic Intrathoracic Chemotherapy for Malignant Pleural Mesothelioma], Oncotarget (2017)</ref>
	<ref name="hithoc_2025">[https://dandell.com/mesothelioma/treatment/ HITHOC and Multimodal Mesothelioma Treatment], Danziger & De Llano</ref>		<ref name="hithoc_2025">[https://dandell.com/mesothelioma/treatment/ HITHOC and Multimodal Mesothelioma Treatment], Danziger & De Llano</ref>
	<ref name="hithoc_renal">[https://~~pmc~~.ncbi.nlm.nih.gov/~~articles~~/~~PMC6722490/ Renal Safety of~~ Hyperthermic Intrathoracic ~~Cisplatin~~ Chemotherapy], ~~PMC~~/National Library of Medicine</ref>		<ref name="hithoc_renal">[https://pubmed.ncbi.nlm.nih.gov/34572806/ Hyperthermic Intrathoracic Chemotherapy (HITOC) after Cytoreductive Surgery for Pleural Malignancies — A Retrospective, Multicentre Study (Klotz et al. 2021)], PubMed / National Library of Medicine</ref>
	<ref name="pd_complications">[https://dandell.com/mesothelioma/treatment/surgery/ Pleurectomy/Decortication Complication Rates and Outcomes], Danziger & De Llano</ref>		<ref name="pd_complications">[https://dandell.com/mesothelioma/treatment/surgery/ Pleurectomy/Decortication Complication Rates and Outcomes], Danziger & De Llano</ref>
	<ref name="pd_meta_complications">[https://dandell.com/mesothelioma/surgery/ P/D Versus EPP: Comparative Complication Analysis], Danziger & De Llano</ref>		<ref name="pd_meta_complications">[https://dandell.com/mesothelioma/surgery/ P/D Versus EPP: Comparative Complication Analysis], Danziger & De Llano</ref>
	<ref name="pd_empyema">[https://~~pmc~~.ncbi.nlm.nih.gov/~~articles/PMC7578483~~/ Empyema After Pleurectomy/Decortication~~: Impact on Outcomes~~], ~~PMC~~/National Library of Medicine</ref>		<ref name="pd_empyema">[https://pubmed.ncbi.nlm.nih.gov/34619137/ Postoperative Empyema After Pleurectomy Decortication for Malignant Pleural Mesothelioma (Lapidot et al. 2022)], PubMed / National Library of Medicine</ref>
	<ref name="msk_morbidity">[https://pmc.ncbi.nlm.nih.gov/articles/~~PMC10629844~~/ Morbidity ~~Reduction Strategies After~~ Pleurectomy/Decortication], PMC/National Library of Medicine ~~(2023)~~</ref>		<ref name="msk_morbidity">[https://pmc.ncbi.nlm.nih.gov/articles/PMC10518225/ Strategies to Reduce Morbidity Following Pleurectomy and Decortication for Malignant Pleural Mesothelioma (Bou-Samra et al. 2023)], PMC / National Library of Medicine</ref>
	<ref name="pd_history">[https://mesotheliomaattorney.com/mesothelioma/treatment/surgery/ History and Evolution of Mesothelioma Surgery], MesotheliomaAttorney.com</ref>		<ref name="pd_history">[https://mesotheliomaattorney.com/mesothelioma/treatment/surgery/ History and Evolution of Mesothelioma Surgery], MesotheliomaAttorney.com</ref>
	<ref name="nct_pd">[https://clinicaltrials.gov/study/NCT07126509 Partial Pleurectomy for Unresectable Malignant Pleural Mesothelioma], ClinicalTrials.gov</ref>		<ref name="nct_pd">[https://clinicaltrials.gov/study/NCT07126509 Partial Pleurectomy for Unresectable Malignant Pleural Mesothelioma], ClinicalTrials.gov</ref>