Extrapleural pneumonectomy plus rib resection for malignant pleural mesothelioma: a case report

Our plain-English summary of Extrapleural pneumonectomy plus rib resection for malignant pleural mesothelioma: a case report, by Y. Yamashita, H. Harada, H. Mukaida, et al (Journal of Cardiothoracic Surgery, 2014).

The study

• Authors: Y. Yamashita, H. Harada, H. Mukaida, M. Kaneko
• Journal: Journal of Cardiothoracic Surgery
• Published: 2014;9:176
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We report a case of a 58-year-old Japanese man with epithelioid-type MPM, with a left chest wall protruding tumor, who underwent extrapleural pneumonectomy and chest wall resection. Postsurgical pathology showed that surgical margins were free of mesothelioma cells. Positron emission tomography taken 5 years after surgery showed no recurrence at any site, suggesting that long-term survival could be dependent on margin-free tumor resection or that specific MPM subgroups have lower malignant potential, leading to improved survival.

In plain English

This article was a case report about one patient: a 58-year-old Japanese man with epithelioid-type malignant pleural mesothelioma. He had worked in the electrical industry for 40 years. The article does not report any asbestos or other fiber exposure for this patient. His 6-cm tumor protruded from the left chest wall, invading between the first two ribs, and was classed as stage III. Before surgery he received OK-432 into the chest. Surgeons then performed an extrapleural pneumonectomy with lymph node dissection, combined with removal of the first two ribs, the pericardium and the diaphragm. The operation took 490 minutes, with 1085 g of blood loss. Pathology found that all surgical margins were tumor-free. He declined the recommended chemotherapy and radiation after surgery. He was followed for 64 months, and a scan showed no recurrence for more than 5 years after surgery. The authors concluded that long-term survival could depend on removing the tumor with tumor-free margins, or that some subgroups of this disease have lower malignant potential. Because this is a single case, it describes one person's outcome, not a rate.

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 (a single patient)
• Who was studied: One 58-year-old Japanese man admitted with left chest pain, diagnosed with epithelioid-type malignant pleural mesothelioma (clinical T3N0M0, stage III) with a 6-cm tumor protruding from the anterior chest wall
• Exposure: The article gives only the patient's work history: 40 years in the electrical industry. It does not report any asbestos or other fiber exposure, or any measured exposure, for this patient.
• Main results:
  • In this patient, pathology confirmed that all surgical margins were tumor-free. The authors examined 36 paraffin-embedded blocks, including samples from the pericardium, diaphragm and chest wall.
  • The operation (extrapleural pneumonectomy with mediastinal lymph node dissection and resection of the first two ribs, pericardium and diaphragm) had blood loss of 1085 g and lasted 490 minutes.
  • Immunohistochemistry after surgery confirmed epithelioid-type mesothelioma. The tumor cells' Ki67 labeling index was 30–40% and their p53 labeling index was 10%.
  • The patient refused the recommended chemotherapy and radiation after surgery. He was followed up for 64 months, and a positron emission tomography scan showed no recurrence at any site for more than 5 years after surgery.
• The authors' conclusion: The authors concluded that the case suggests long-term survival could depend on removing the tumor with tumor-free margins, or that some subgroups of malignant pleural mesothelioma have lower malignant potential, leading to better survival. In their discussion they also raised the possibility that the OK-432 given before surgery had an antitumor effect.

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: Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma, Epithelioid, Pathology, Mesothelioma.

Related studies

• Interim results of pleurectomy/decortication and intraoperative intrapleural hyperthermic cisplatin perfusion for patients with malignant pleural mesothelioma intolerable to extrapleural pneumonectomy — H. Ishibashi, M. Kobayashi, et al. (2015)
• Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial) — S. Hasegawa, M. Okada, et al. (2016)
• Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma — D.R. Gomez, D.S. Hong, et al. (2013)
• Extrapleural pneumonectomy for early stage malignant pleural mesothelioma: a harmful procedure — O. Rena, C. Casadio (2012)
• Second surgery for recurrence of malignant pleural mesothelioma after extrapleural pneumonectomy — L. Politi, G. Borzellino (2010)
• Pattern of failure after adjuvant radiotherapy following extrapleural pneumonectomy of pleural mesothelioma in the SAKK 17/04 trial — O. Riesterer, I.F. Ciernik, et al. (2019)

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