Chest wall resection for mesothelioma recurrence after surgery

Our plain-English summary of Chest wall resection for mesothelioma recurrence after surgery, by P. Bertoglio, O. Fanucchi, S. Ricciardi, et al (Asian Cardiovascular & Thoracic Annals, 2016).

The study

• Authors: P. Bertoglio, O. Fanucchi, S. Ricciardi, A. Chella, M. Lucchi, A. Mussi
• Journal: Asian Cardiovascular & Thoracic Annals
• Published: 2016;24(9):893-895
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma is an aggressive and usually fatal disease, and its optimal management is still under debate. Surgery for recurrent malignant mesothelioma has been reported rarely in highly selected cases. We report a case of chest wall resection for local recurrence of epithelioid mesothelioma 3 years after cytoreductive surgery. Our patient experienced a 6-month disease-free survival after redo surgery, with complete resolution of his chest pain and discomfort.

© The Author(s) 2016.

In plain English

This case report from the University Hospital of Pisa, Italy, described one patient. A 64-year-old Caucasian man with right epithelioid pleural mesothelioma first had surgery to remove visible tumour, then heated chemotherapy inside the chest, then further chemotherapy and radiotherapy. Two years later the disease returned on the lower right chest wall, involving the rib cage and diaphragm. It was treated with radiotherapy but grew again a year later, with no sign of spread elsewhere. Surgeons then removed the 9th, 10th and 11th ribs, the edge of the diaphragm and part of a muscle, and rebuilt the rib cage with two metal bars. There were no complications, but cancer cells were found at the edges of the removed tissue. After more radiotherapy and chemotherapy, a new lesion appeared in the chest muscles six months later. The patient was alive with progressing disease when the article was written. The authors concluded that surgery for recurrence is feasible in carefully selected patients. They noted that it is very difficult to judge how much the operation helped. The article did not mention asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 64-year-old Caucasian man with right epithelioid malignant pleural mesothelioma, treated at the University Hospital of Pisa, Italy. Dates of treatment are not given.
• Exposure: Not reported. The article does not describe any asbestos or other exposure history. It describes treatment only.
• Main results:
  • First treatment for the patient: diaphragm- and pericardium-sparing pleurectomy with focal decortication, followed by hyperthermic intrathoracic chemotherapy (cisplatin 80 mg per square metre and doxorubicin 25 mg per square metre at 42.5 degrees C for 60 minutes). Pathology confirmed epithelioid mesothelioma T2N2M0, International Mesothelioma Interest Group stage III. He then had 6 cycles of pemetrexed and cisplatin and 48 Gy radiotherapy to the mediastinum.
  • Two years after surgery, a local recurrence was found on the lower part of the patient's right chest wall, involving the rib cage and diaphragm. It was first treated with radiotherapy. A year later it had progressed in the same area, with no evidence of distant recurrence.
  • In the second operation, the patient's 9th, 10th and 11th ribs were removed with the lateral edge of the diaphragm and part of the internal oblique muscle. The rib cage was reconstructed with two metallic bars. There were no postoperative complications.
  • Pathology confirmed recurrent epithelioid mesothelioma in the ribs and muscle layer, with malignant cells present in the resection margins.
  • After an additional 45 Gy of radiotherapy and 6 cycles of cisplatin and pemetrexed, a new lesion invading the pectoralis major and underlying intercostal muscles was found six months later.
  • At the time of writing, the patient was alive with progressing disease and receiving vinorelbine chemotherapy, with no signs of further recurrence at the site of the chest wall resection.
• The authors' conclusion: The authors considered surgery for mesothelioma recurrence feasible depending on the patient's clinical condition and the features of disease progression. They considered that extended procedures such as chest wall resection can be performed safely and successfully. They added that careful patient selection and multidisciplinary discussion are always mandatory.
• Limitations the authors state:
  • The authors stated that it is very difficult to assess how, and how much, the repeat surgery may have improved the patient's prognosis. Their suggested benefit of extra tumour removal is described as speculation.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Malignant Mesothelioma, Epithelioid, Cytoreductive Surgery, Disease-Free Survival.

Related studies

• Clinical indications and results after chest wall resection for recurrent mesothelioma — B.M. Burt, S.O. Ali, et al. (2013)
• Long-term results of chest wall reconstruction with DualMesh — T. Nagayasu, N. Yamasaki, et al. (2010)
• Morbidity of the abdominal wall resection and reconstruction after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) — M.F. Nunez, A. Sardi, et al. (2015)
• Initial experience with the use of biological implants for soft tissue and chest wall reconstruction in thoracic surgery — A. Barua, J.A. Catton, et al. (2012)
• Recurrence of Pericardial Mesothelioma Affecting the Myocardium After Pericardial Resection — M. Rodríguez, H.R. Mallidi, et al. (2018)
• Second surgery for recurrence of malignant pleural mesothelioma after extrapleural pneumonectomy — L. Politi, G. Borzellino (2010)

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