Metachronous Lung Cancer After Pleurectomy/Decortication

Our plain-English summary of Metachronous Lung Cancer After Pleurectomy/Decortication, by Y. Kai, Y. Tsutani, M. Ito, et al (The Annals of Thoracic Surgery, 2019).

The study

• Authors: Y. Kai, Y. Tsutani, M. Ito, T. Mimura, Y. Miyata, M. Okada
• Journal: The Annals of Thoracic Surgery
• Published: 2019;107(1):e1-e3
• Read it: PubMed · Publisher

Abstract

Pleurectomy/decortication is a surgical procedure for malignant pleural mesothelioma (MPM) and has been proposed as an alternative to extrapleural pneumonectomy. We report a second primary lung cancer developing after pleurectomy/decortication for MPM. A 59-year-old man was diagnosed with MPM on the right side and underwent pleurectomy/decortication. Follow-up computed tomography detected a nodule in the right upper lobe that was diagnosed as adenocarcinoma by wedge resection. Lung cancer and MPM are associated with asbestos exposure. However, predicting lung cancer after treatment for MPM is difficult. Careful follow-up of the spared lung is necessary for detecting second primary lung cancer or MPM recurrence.

Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This is a case report of one patient, written by surgeons at Hiroshima University, Japan. A 59-year-old man with a history of asbestos exposure was diagnosed with malignant pleural mesothelioma on the right side. It was of the epithelioid type, stage II. He received cisplatin and pemetrexed chemotherapy, then pleurectomy/decortication, an operation that removes the pleura but keeps the lung. A CT scan 1 year and 9 months later showed a 1-cm nodule in the right upper lobe. It grew to 1.3 cm over a year, and a blood marker (CEA) rose to 30 ng/ml. A biopsy taken through the airway gave no clear answer, so the surgeons removed a wedge of lung. Adhesions were extremely severe, and air leaks were covered with a back-muscle (latissimus dorsi) flap. The final diagnosis was a second primary lung cancer, a solid adenocarcinoma measuring 15 mm. The patient was free of recurrence 5 years after the first operation. The authors concluded that doctors should recognize the possibility of a second primary lung cancer even after treatment for mesothelioma.

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 (one patient)
• Who was studied: One 59-year-old man with right-sided malignant pleural mesothelioma, reported by the Department of Surgical Oncology, Hiroshima University, Japan; dates of treatment not given
• Exposure: The patient had a history of asbestos exposure; no fiber type, job, product or dose is given
• Main results:
  • The mesothelioma was treated with neoadjuvant cisplatin (75 mg/m2) and pemetrexed (500 mg/m2) followed by pleurectomy/decortication
  • Final diagnosis of the pleural tumor: malignant epithelioid mesothelioma, pT2N0M0 stage II
  • A CT scan 1 year and 9 months after the operation showed a 1-cm right upper lobe nodule, which grew to 1.3 cm over a year, with serum CEA rising to 30 ng/ml
  • A transbronchial lung biopsy did not give a conclusive diagnosis, so wedge resection was performed
  • Adhesions between the chest wall and lung were extremely severe; major air leaks were covered with a latissimus dorsi muscle flap
  • The lung nodule was diagnosed as solid adenocarcinoma of the lung, T1b (15 mm); staining was positive for thyroid transcription factor-1 and CEA and negative for calretinin, D2-40 and Wilms tumor-1
  • The patient was recurrence-free 5 years after pleurectomy/decortication
• The authors' conclusion: The authors concluded that this was the first reported case of metachronous mesothelioma and second primary lung cancer, and that the possibility of second primary lung cancer must be recognized even after mesothelioma treatment. They also stated that they do not recommend anatomical lung resection for lung cancer after pleurectomy/decortication.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Pleurectomy/Decortication (P/D), Pleural Mesothelioma, Extrapleural Pneumonectomy (EPP), Adenocarcinoma, Asbestos Exposure.

Related studies

• A feasibility study of induction pemetrexed plus cisplatin followed by pleurectomy/decortication aimed at macroscopic complete resection for malignant pleural mesothelioma — M. Shimokawa, S. Hasegawa, et al. (2013)
• Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma — E. Taioli, A.S. Wolf, et al. (2015)
• A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma — V. Rusch, L. Saltz, et al. (1994)
• Pleurectomy/decortication is superior to extrapleural pneumonectomy in the multimodality management of patients with malignant pleural mesothelioma — L. Lang-Lazdunski, A. Bille, et al. (2012)
• Extended Pleurectomy-Decortication-Based Treatment for Advanced Stage Epithelial Mesothelioma Yielding a Median Survival of Nearly Three Years — J.S. Friedberg, C.B. Simone, et al. (2017)
• Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine, prophylactic radiotherapy, and systemic chemotherapy in patients with malignant pleural mesothelioma: a 10-year experience — L. Lang-Lazdunski, A. Bille, et al. (2015)

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