Since Butchart and coworkers published the first series on pleuropneumonectomy for the treatment of malignant pleural mesothelioma (MPM) in 1976, the perioperative mortality associated with this operation has decreased from 31% to 3.4%, similar to that of mitral valve replacement, coronary artery bypass graft surgery, and Whipple procedure. There are only 3000 new cases of MPM in the US each year compared with an estimated 222,520 new cases of lung cancer. MPM is a very aggressive local/regional disease for which survival without treatment is 4 to 12 months. Single-modality therapy alone (ie, surgery or chemotherapy or radiotherapy) is largely ineffective. Univariate analysis in a case series from Brigham and Women's Hospital identified 3 prognostic variables associated with improved survi...
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