Successful lung-sparing resection of synchronous pleural mesothelioma and contralateral lung cancer

Our plain-English summary of Successful lung-sparing resection of synchronous pleural mesothelioma and contralateral lung cancer, by N. Imanishi, Y. Nabe, M. Takenaka, et al (Surgical Case Reports, 2017).

The study

• Authors: N. Imanishi, Y. Nabe, M. Takenaka, Y. Chikaishi, K. Kuroda, H. Noguchi, K. Yatera, F. Tanaka
• Journal: Surgical Case Reports
• Published: 2017;3(1):64
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is an uncommon malignant tumor, and its synchronous occurrence with primary lung cancer is extremely rare. Here, we report the first surgical case of synchronous MPM and contralateral lung adenocarcinoma. Extrapleural pneumonectomy (EPP) combined with surgery for contralateral lung cancer may not be tolerated, and a lung-sparing procedure including pleurectomy/decortication (P/D) can be an alternative to achieve complete resection.

Case Presentation: A 69-year-old male with right MPM and lung adenocarcinoma in the left upper lobe presented. Two lesions were judged to be synchronous MPM and lung cancer that were both potentially resectable clinical stage I diseases, and complete resection of both tumors was successfully achieved with right P/D following left upper division segmentectomy.

Conclusions: P/D, not EPP, is a less invasive surgical procedure for MPM with curative intent and can be performed in combination with contralateral lung resection.

In plain English

This case report from the University of Occupational and Environmental Health in Kitakyushu, Japan, described one 69-year-old man with a history of occupational asbestos exposure. The article did not name the job or the fiber type. A biopsy diagnosed malignant pleural mesothelioma (epithelioid type) on the right side. At the same time, a lung adenocarcinoma was found in the left upper lobe. Breathing tests indicated the patient could not tolerate removal of the whole right lung (extrapleural pneumonectomy) combined with left lung surgery. The surgeons first removed part of the left upper lobe by video-assisted surgery. Three weeks later they removed the right pleura (pleurectomy/decortication) together with involved diaphragm and pericardium, and both tumors were completely removed as far as could be seen. Final pathology showed biphasic mesothelioma, stage III, and a stage IA2 lung cancer. Recovery was uneventful, and chemotherapy with cisplatin plus pemetrexed was prescribed. The authors concluded that pleurectomy/decortication can be performed for patients who might not be eligible for extrapleural pneumonectomy, even combined with surgery on the other lung.

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 male patient with right malignant pleural mesothelioma and left upper lobe lung adenocarcinoma, treated at the University of Occupational and Environmental Health, Kitakyushu, Japan (article received 2017)
• Exposure: History of occupational asbestos exposure; no job, fiber type or dose given
• Main results:
  • Before surgery, a thoracoscopic biopsy diagnosed the right pleural tumor as epithelioid malignant pleural mesothelioma. A transbronchial biopsy diagnosed the left upper lobe nodule as lung adenocarcinoma. Both were judged to be clinical stage I and potentially resectable, with no nodal or distant spread found.
  • The patient's predicted forced expiratory volume in 1 second after surgery was 0.96 after right extrapleural pneumonectomy alone, 0.70 with added left upper division segmentectomy, and 0.43 with added left upper lobectomy (units printed as L/mm2). The authors read this as meaning the patient may not tolerate extrapleural pneumonectomy combined with left lung resection.
  • Left upper division segmentectomy was done first by video-assisted surgery. Three weeks later, extended pleurectomy/decortication with resection of involved diaphragm and pericardium achieved macroscopic complete resection of the right mesothelioma.
  • Final pathology showed biphasic malignant pleural mesothelioma, pathologic stage III, because the tumor had invaded the diaphragm and chest wall. The lung tumor was papillary adenocarcinoma, pathologic T1bN0M0, stage IA2.
  • The patient recovered without complications, and adjuvant chemotherapy with cisplatin plus pemetrexed was prescribed.
• The authors' conclusion: The authors concluded that pleurectomy/decortication can be performed for patients who might not be eligible for extrapleural pneumonectomy, and that in this case it was performed together with contralateral lung resection.

Topics

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

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