Clinical indications and results after chest wall resection for recurrent mesothelioma

Our plain-English summary of Clinical indications and results after chest wall resection for recurrent mesothelioma, by B.M. Burt, S.O. Ali, M.C. DaSilva, et al (The Journal of Thoracic and Cardiovascular Surgery, 2013).

The study

• Authors: B.M. Burt, S.O. Ali, M.C. DaSilva, B.Y. Yeap, W.G. Richards, E.H. Baldini, D.J. Sugarbaker
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2013;146(6):1373-9; discussion 1379-80
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: The ipsilateral hemithorax is the most common site of recurrence after surgical resection for malignant pleural mesothelioma. Salvage treatment has generally been ineffective. We reviewed the outcomes after resection of isolated ipsilateral chest recurrence after cytoreductive surgery in patients with malignant pleural mesothelioma.

Methods: Patients with malignant pleural mesothelioma who underwent initial surgical resection at our institution from 1988 to 2011 and were subsequently treated for localized recurrence with an additional chest resection were identified and their data retrospectively reviewed.

Results: A total of 1142 patients underwent either extrapleural pneumonectomy (n = 794) or pleurectomy/decortication (n = 348). Of the patients who returned for follow-up, 47 (4.1%) had chest wall recurrence amenable to resection. The location of recurrence was predominantly incisional (49%) and/or costophrenic (38%). The median time to recurrence after either extrapleural pneumonectomy or pleurectomy/decortication was 16.1 months (range, 2.7-58.2). No 30-day mortality was found for chest wall resection, and the median length of stay in the hospital was 3 days (range, 0-12). The median overall survival duration after chest wall resection correlated positively with the time to recurrence (epithelial: median, 8.9, 17.2, and 35.8 months for a time to recurrence of <12, 12 to <24, and ≥24 months, respectively; biphasic: median, 2.7 and 15.9 months for a time to recurrence of <10 and ≥10 months, respectively).

Conclusions: Chest wall resection is a safe and effective therapeutic option in the management of localized chest wall recurrence of malignant pleural mesothelioma. The time to recurrence appears to be predictive of the expected survival benefit in both epithelial and biphasic malignant pleural mesothelioma.

Copyright © 2013. Published by Mosby, Inc.

In plain English

This study looked back at records of patients with malignant pleural mesothelioma treated at Brigham and Women's Hospital. It covered 1988 to 2011 and did not examine asbestos exposure. Of 1142 patients who had a first operation (extrapleural pneumonectomy or pleurectomy/decortication), 47 (4.1%) later had a single cancer recurrence on the same side's chest wall that was surgically removed. No patient died within 30 days of the chest wall operation, and the median hospital stay was 3 days. Recurrences appeared a median of 16.1 months after the first operation, most often at the original surgical incision (49%) or the lower chest (38%). Median survival after chest wall surgery was 20.4 months for epithelial tumors and 7.4 months for biphasic tumors. Within each tumor type, survival was longer when recurrence came later. The authors concluded that chest wall resection was an effective option for select patients. They noted that the study was retrospective and the patients were highly selected.

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: Retrospective review of hospital registry records (case series of patients treated surgically for recurrence)
• Who was studied: 47 patients with malignant pleural mesothelioma who underwent chest wall resection for a solitary recurrence on the same side of the chest. They came from 1142 patients who had extrapleural pneumonectomy (794) or pleurectomy/decortication (348) at Brigham and Women's Hospital, Boston, from January 1, 1988, through January 31, 2011. Median age was 61.9 years and 77% were men. 68% had epithelial histology and 32% biphasic; there were no sarcomatoid cases.
• Exposure: The article does not report asbestos exposure. What was studied was surgical treatment: chest wall resection, defined as removal of at least 1 rib, possibly with adjacent structures, for recurrence after the initial operation.
• Main results:
  • Among the 47 patients who had chest wall resection, 30-day mortality was 0%. No complications such as wound infection, bleeding, or dehiscence were seen.
  • Median hospital stay after chest wall resection was 3 days (range, 0-12).
  • Recurrences were located at the original thoracotomy incision in 49%, the costophrenic region in 38%, and the axilla or upper chest in 9%.
  • Median time to recurrence was 16.1 months (range, 2.7-58.2) for the whole group. It was 23.4 months for epithelial type and 11.2 months for biphasic type, a statistically significant difference (P = .022).
  • Median survival after chest wall resection was 20.4 months (range, 1-73.1) for patients with epithelial histology. It was 7.4 months (range, 1.3-34.7) for those with mixed (biphasic) histology (P = .01).
  • For epithelial-type patients, median survival after chest wall resection depended on time to recurrence. It was 35.8 months when recurrence came at 24 months or longer, 17.2 months at 12 to less than 24 months, and 8.9 months at less than 12 months (P = .001).
  • For biphasic-type patients, median survival after chest wall resection was 15.9 months when time to recurrence was 10 months or longer. It was 2.7 months when recurrence came at less than 10 months (P = .002).
  • Overall median survival from the initial surgery, for all patients who had chest wall resection, was 44.9 months (range, 3.8-130.5).
  • Of the 47 patients, 16 (34%) had a repeat chest wall resection for a second recurrence, and 3 had a third.
  • Of the 15 patients with biphasic tumors at the first operation, 10 showed epithelial (8) or sarcomatoid (2) features at chest wall resection. All 32 epithelial patients kept epithelial histology.
• The authors' conclusion: The authors concluded that, for select patients with isolated chest wall recurrence, salvage chest wall resection was an effective strategy with favorable survival and minimal morbidity. They added that patients with a longer time to recurrence benefit most.
• Limitations the authors state:
  • The study was retrospective and the patient group was highly selected.
  • Follow-up of all 1142 patients was not sufficient to estimate how often resectable chest wall recurrence occurs.
  • Many patients received other treatments, including adjuvant therapy and chemotherapy or radiotherapy for recurrence, so the contribution of surgery alone is hard to separate.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Hemithorax, Surgical Resection, Pleural Mesothelioma, Cytoreductive Surgery, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D), Median Overall Survival.

Related studies

• Chest wall resection for mesothelioma recurrence after surgery — P. Bertoglio, O. Fanucchi, et al. (2016)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)
• Multimodal therapy of malignant pleural mesothelioma: is the replacement of radical surgery imminent? — J. Lindenmann, V. Matzi, et al. (2013)
• Long-term results of chest wall reconstruction with DualMesh — T. Nagayasu, N. Yamasaki, et al. (2010)
• En bloc resection of the recurrent pleural mesothelioma and reconstruction of the chest wall after immunotherapy: A case report — C. Qin, Q. Xia, et al. (2023)
• Treatment of malignant pleural mesothelioma with chemotherapy preceding versus after surgical resection — V. Verma, C.A. Ahern, et al. (2019)

Browse more research in The Journal of Thoracic and Cardiovascular Surgery, or return to medical research.