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Adding lung-sparing radical surgery to chemotherapy for pleural mesothelioma did not lengthen life; patients who had surgery lived slightly less long, had more complications and worse quality of life, so routine surgery is no longer recommended.
Multicentre randomised trial in the United Kingdom of 335 patients with resectable pleural mesothelioma randomised to extended pleurectomy decortication plus platinum-pemetrexed chemotherapy or chemotherapy alone.
Median overall survival was 19.3 months with surgery against 24.8 months without (hazard ratio 1.28); surgery caused more serious adverse events and worse quality of life in the first year, at higher cost.
Radical surgery for pleural mesothelioma should be confined to trials; effusion is managed with pleurodesis or indwelling catheters and treatment is systemic.