Malignant pleural mesothelioma (MPM) is a very aggressive tumor with poor prognosis. Unlike other solid malignancies, the aim of surgery for MPM is cytoreductive rather than radical. Surgery is performed as multimodality therapy in MPM, combining extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). An en-bloc resection of the pleura, lung, diaphragm, and pericardium is performed in EPP. P/D is a lung-sparing procedure that removes the pleura alone without the lung parenchyma. P/D is less invasive and preserves greater cardiopulmonary function compared with EPP, which leads to good postoperative quality of life (QOL). Tumor recurrence is more frequent after P/D, but it is possible to perform additional treatment because cardiopulmonary function is preserved and QOL is maintained. P/D is a feasible curative surgical treatment for MPM, and it will be performed more frequently in Japan.