Objective: Surgery can only offer palliation in an attempt to slow the progression of malignant pleural mesothelioma (MPM), We want to assess the effectiveness and safety of pleurectomy/decortication in establishing a tissue diagnosis, and controlling pleural fluid accumulation and symptoms in patients with MPM. Methods: We reviewed our pleurectomy results in 100 patients with MPM over a 19 year period. Major symptoms were chest pain, cough and dyspnea, and radiographic findings included pleural mass, pleural fluid and constriction of involved hemithorax. Results: Approximately two thirds of the patients underwent underwent subtotal (44%) or total pleurectomy (56%). The surgical mortality rate was 1% (1/100) and the morbidity rate was 22%. Morbidity included prolonged air leak (n = 12), empyema (n = 6), reaccumulation of pleural fluid (n = 2) and wound infection (n = 2). Palliative results included dyspnea and cough relief in all patients, chest pain relief in 60 (85%) and pleural fluid control in 52 (96%) patients. Median survival was 17 months in MPM patients. Conclusions: We conclude that pleurectomy/decortication safely provides both tissue diagnosis and effective control of pleural effusion and symptoms and therefore excellent palliation in patients with MPM. (C) 1997 Elsevier Science B.V.