Non-incisional pleurectomy/decortication for malignant mesothelioma after cardiac surgery

Our plain-English summary of Non-incisional pleurectomy/decortication for malignant mesothelioma after cardiac surgery, by K. Miura, K. Shimizu, S. Hasegawa, et al (Thoracic Cancer, 2022).

The study

• Authors: K. Miura, K. Shimizu, S. Hasegawa, S. Koike, S. Matsuoka, T. Takeda, T. Eguchi, K. Hamanaka, M. Takizawa
• Journal: Thoracic Cancer
• Published: 2022;13(1):126-128
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 70-year-old man diagnosed with right-sided malignant epithelial pleural mesothelioma, underwent pleurectomy/decortication after three courses of neoadjuvant chemotherapy. He had a history of mitral valve replacement and maze procedure with median sternotomy, and the procedures resulted in strong adhesion from the apex to the mediastinal side. In particular, the peeling of the area where the tumor invaded the pericardium required the most attention; however, the involved pericardium could be partially resected without damaging the right atrium. Finally, en bloc macroscopic complete resection with the entire pleura was successfully performed without conversion to extrapleural pneumonectomy.

© 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

In plain English

This case report described one patient: a 70-year-old man with right-sided epithelial malignant pleural mesothelioma, stage IB. Two years earlier he had had heart surgery (mitral valve replacement and a maze procedure) through the breastbone. The article does not mention asbestos exposure. After three courses of cisplatin plus pemetrexed chemotherapy, scans showed stable disease and a 2 by 2 cm tumor touching the heart's right atrium. Surgeons then removed the pleura while sparing the lung (pleurectomy/decortication), without cutting the pleura open. Scar adhesions from the earlier heart surgery were strong. The tumor had not directly invaded the right atrium, and part of the involved pericardium was removed without damaging the atrium. The entire pleura was removed in one piece without switching to removal of the lung (extrapleural pneumonectomy). Blood loss was 5300 mL, the operation took 688 minutes, and the patient left hospital 17 days after surgery. The authors concluded that careful peeling made this possible. They recommended preparing for emergency bleeding in similar cases, such as having a heart-lung machine on standby.

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 70-year-old man with right-sided epithelial malignant pleural mesothelioma who had had mitral valve replacement and a maze procedure through median sternotomy 2 years earlier
• Exposure: The article does not report any asbestos or other exposure history.
• Main results:
  • The patient's mesothelioma was staged c-T3N0M0 Stage IB (IASLC 8th edition), with no lymph node or distant metastases on PET-CT.
  • The patient received three courses of cisplatin plus pemetrexed chemotherapy before surgery.
  • After chemotherapy the patient was diagnosed with stable disease, and CT showed a 2 by 2 cm tumor in contact with the right atrium; invasion could not be ruled out.
  • At surgery the pericardium and right atrium were strongly adherent, but the tumor had not directly invaded the right atrium.
  • The involved pericardium was partially removed without damaging the right atrium.
  • En bloc macroscopic complete resection of the entire pleura was performed without conversion to extrapleural pneumonectomy.
  • Total blood loss during the operation was 5300 mL.
  • The operation lasted 688 minutes.
  • The air leak stopped 3 days after surgery, and the patient was discharged 17 days after surgery.
• The authors' conclusion: The authors concluded that they successfully treated this patient with pleurectomy/decortication after cardiac surgery with median sternotomy. Although the adhesions were strong, careful peeling allowed en bloc resection without conversion to extrapleural pneumonectomy. They recommended sufficient preparation for emergency bleeding, such as a heart-lung machine on standby, in similar cases.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleurectomy/Decortication (P/D), Mesothelioma, Pleural Mesothelioma, Neoadjuvant Therapy, Pericardium, Pleura, Extrapleural Pneumonectomy (EPP).

Related studies

• Non-incisional pleurectomy-decortication for malignant pleural mesothelioma — F. Tanaka, N. Imanishi, et al. (2018)
• Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma — S. Hasegawa (2014)
• Non-incisional pleurectomy/decortication for malignant pleural mesothelioma — F. Tanaka, M. Takenaka, et al. (2021)
• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)
• Quality of life after radical pleurectomy decortication for malignant pleural mesothelioma — N.M. Mollberg, Y. Vigneswaran, et al. (2012)
• A Clinical Trial of TumorGlow to Identify Residual Disease During Pleurectomy and Decortication — J.D. Predina, A.D. Newton, et al. (2019)

Browse more research in Thoracic Cancer, or return to medical research.