Second Surgery for Recurrent Malignant Pleural Mesothelioma after Multimodality Treatment: A Systematic Review

Our plain-English summary of Second Surgery for Recurrent Malignant Pleural Mesothelioma after Multimodality Treatment: A Systematic Review, by A. Bellini, S. Mazzarra, S. Sterrantino, et al (Journal of Clinical Medicine, 2022).

The study

• Authors: A. Bellini, S. Mazzarra, S. Sterrantino, D. Argnani, F. Stella
• Journal: Journal of Clinical Medicine
• Published: 2022;11(12)
• Type of article: Review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive asbestos-related tumour with poor prognosis. To date, a multimodality treatment, including chemotherapy and surgery, with or without radiotherapy, is the gold standard therapy for selected patients with epithelioid and early-stage MPM. In this setting, the goal of surgery is to achieve the macroscopic complete resection, obtained by either extrapleural pneumonectomy or pleurectomy/decortication. Failure, in local and/or distant sites, is one of the major concerns; in fact, there has been no established treatment for the recurrence of MPM after the multimodal approach, and the role of surgery in this context is still controversial. By using electronic databases, studies that included recurrent MPM patients who underwent a second surgery were identified. The endpoints included were: a pattern of recurrence, post-recurrence survival (PRS), and the type of second surgery. When available, factors predicting better PRS and perioperative mortality and morbidity were collected. This systematic review offers an overview of the results that are currently obtained in patients undergoing a second surgery for relapsed MPM, with the aim to provide a comprehensive view on this subject that explores if a second surgery leads to an improvement in survival.

In plain English

This systematic review looked at second operations for malignant pleural mesothelioma that returned after multimodality treatment (chemotherapy and surgery, with or without radiotherapy). The authors searched PubMed (January 1980 to December 2021), found 913 studies, and included six, all retrospective. One was an earlier paper by this review's first author. The six studies covered 365 relapsed patients, 89 (24.4%) of whom had a second surgery. Most of the 89 had a local relapse (74, 83.2%) rather than a distant one (15, 16.8%), and chest wall resection was the most common operation (63, 70.8%). In the studies that reported median survival after recurrence for patients who underwent second surgery, it ranged from 14.5 to 23.5 months. One further study gave a single figure that pooled surgically and medically treated patients, and another reported results by tumour subtype. In three studies, survival for all relapsed patients, including those given only supportive care, ranged from 7 to 14.4 months. The authors concluded that surgery seems to be safely employed and associated with good outcomes for a single solid metastasis, preferably local, and that further studies are needed. The review did not examine 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: systematic review of retrospective studies, following PRISMA guidelines
• Who was studied: Six retrospective studies published 2010 to 2021, together covering 365 patients with relapsed malignant pleural mesothelioma after multimodality treatment; found by a PubMed search from January 1980 to December 2021 that identified 913 studies
• Exposure: Second surgery for recurrent malignant pleural mesothelioma after multimodality treatment. Asbestos exposure and fiber types were not studied.
• Main results:
  • Of the 365 relapsed patients in the six studies, 89 (24.4%) underwent a second surgery
  • Among the 89 patients who had a second surgery, it was used mostly for local relapses (74, 83.2%) rather than distant relapses (15, 16.8%)
  • Chest wall resection was the most common second operation (63 patients, 70.8%), occasionally extended (9 patients, 10.1%)
  • Median post-recurrence survival for patients who underwent second surgery ranged from 14.5 months to 23.5 months in the studies reporting it. These surgical groups could also include patients who received other treatments. The authors excepted one study whose figure pooled surgically treated patients with patients given medical therapies. Another study reported survival separately by histologic subtype.
  • In three studies, survival after recurrence for all relapsed patients, including those who received only best supportive care, ranged from 7 to 14.4 months
  • Factors reported across studies as associated with longer post-recurrence survival included disease-free survival, epithelioid histology, local recurrence, post-recurrence treatments and good performance status (ECOG 0 to 1)
  • One included study (Kostron et al.) reported a 12.5% rate of major complications ending in death with contralateral partial pleurectomy
• The authors' conclusion: The authors concluded that surgical resection seems to be safely employed and associated with good outcomes for a single solid metastasis, preferably local, and that careful patient selection by a multidisciplinary team matters.
• Limitations the authors state:
  • All included studies were retrospective
  • No prospective studies exist to guide the choice of surgery for recurrence
  • Further studies are needed

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Systematic Review, Prognosis, Chemotherapy, Epithelioid, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D).

Related studies

• Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma — A. Kostron, M. Friess, et al. (2016)
• A systematic review and meta-analysis of second-line therapies for treatment of mesothelioma — F. Petrelli, R. Ardito, et al. (2018)
• Pretreatment serum C-reactive protein levels predict benefit from multimodality treatment including radical surgery in malignant pleural mesothelioma: a retrospective multicenter analysis — B. Ghanim, M.A. Hoda, et al. (2012)
• The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: a systematic review including evidence from Japan — T. Kitai (2021)
• Second line therapy in malignant pleural mesothelioma: A systematic review — W.A. Buikhuisen, B.I. Hiddinga, et al. (2015)
• Second surgery for recurrence of malignant pleural mesothelioma after extrapleural pneumonectomy — L. Politi, G. Borzellino (2010)

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