Prognostic coronary surgery in a case of malignant mesothelioma previously managed with trimodality treatment

Our plain-English summary of Prognostic coronary surgery in a case of malignant mesothelioma previously managed with trimodality treatment, by V. Dhurandhar, B.M. Robinson, B.C. McCaughan, et al (Heart, Lung & Circulation, 2014).

The study

• Authors: V. Dhurandhar, B.M. Robinson, B.C. McCaughan, C. Bulliard, P.G. Bannon
• Journal: Heart, Lung & Circulation
• Published: 2014;23(10):e198-201
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

We report a case of malignant pleural mesothelioma treated with trimodality treatment. At three years after the extrapleural pneumonectomy, coronary artery revascularisation surgery for NSTEMI was performed in view of favourable long term prognostic and survival outcome. Five years following pleuropneumonectomy there is no clinical or radiological evidence of mesothelioma and the patient remains free of cardiac symptoms.

Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

In plain English

This was a case report about one patient treated in Sydney, Australia. A 69-year-old man with a history of asbestos exposure (type not given) and past smoking had a large collection of fluid around his right lung containing malignant cells. Biopsy confirmed epithelial malignant pleural mesothelioma. He received trimodality treatment: chemotherapy before surgery, a right extrapleural pneumonectomy, and radiotherapy afterwards. Tissue examination showed asbestos bodies, clear margins and no lymph node involvement. Thirty-four months after surgery he had a heart attack called a non-ST elevation myocardial infarction. A stent procedure was complicated by a tear in the artery wall, and he had coronary bypass surgery the next day. A pleural biopsy taken during that operation showed scarring and inflammation only, with no malignancy. At follow-up 52 months after the lung surgery, he had no symptoms and no signs of recurrence on imaging. After discussion with him and his family, the authors judged that as a long-term survivor he would benefit from revascularisation, at least in the short term. Ongoing ischaemia and the torn artery left emergency surgery as the only choice.

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 69-year-old man with malignant pleural mesothelioma, treated in Sydney, Australia; he also had polycythaemia vera, COPD, hypertension and high cholesterol, and a 20-pack-year smoking history (stopped 35 years earlier)
• Exposure: a history of asbestos exposure; no fiber type, job, product or dose is given. Classical asbestos bodies were seen in the removed tissue.
• Main results:
  • Histopathology confirmed epithelial type mesothelioma, with clear margins and no nodal or port site involvement
  • The patient received neoadjuvant chemotherapy (pemetrexed and cisplatin based, according to the discussion), right extrapleural pneumonectomy and adjuvant radiotherapy
  • Thirty-four months after the extrapleural pneumonectomy the patient had an inferior non-ST elevation myocardial infarction. A stent procedure was complicated by a vessel wall dissection, and coronary bypass surgery followed the next day.
  • Emergency bypass surgery was considered because of ongoing ischaemia and critical coronary lesions. Further percutaneous intervention was not an option because of the dissected vessel, and the authors judged that death was likely without intervention.
  • A right pleural biopsy taken during the bypass surgery showed fibrotic inflammatory changes only, with material consistent with talc and no malignancy
  • At follow-up 52 months after the extrapleural pneumonectomy (56 months after first presentation), the patient had no symptoms and no radiologic evidence of recurrence. He had received no further therapy after the initial treatment.
• The authors' conclusion: After discussion with the patient and his family, and considering his status as a long-term survivor after trimodality treatment, the authors judged that he would benefit from coronary revascularisation, at least in the short term. They described surgery as the only choice because of ongoing ischaemia and the dissected vessel. They stressed the value of an integrated team involving a cardiac and a lung surgeon.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pleural Mesothelioma, Extrapleural Pneumonectomy (EPP), Mesothelioma.

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• Integrated positron emission tomography-computed tomography does not accurately stage intrathoracic disease of patients undergoing trimodality therapy for malignant pleural mesothelioma — J. Pilling, J.A. Dartnell, et al. (2010)
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