Surgical Diagnosis of Malignant Pleural Mesothelioma: 20 Years' Experience at a High-Volume Referral Center

Our plain-English summary of Surgical Diagnosis of Malignant Pleural Mesothelioma: 20 Years' Experience at a High-Volume Referral Center, by A. Iaffaldano, T. Charrier, F. Lococo, et al (Journal of Clinical Medicine, 2021).

The study

• Authors: A. Iaffaldano, T. Charrier, F. Lococo, D. Damotte, A. Bobbio, M. Alifano, L. Fournel
• Journal: Journal of Clinical Medicine
• Published: 2021;10(9)
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Despite advances, malignant pleural mesothelioma (MPM) remains a challenging disease in terms of diagnosis, treatment, and overall management. Herein, we analyzed, in a large-scale single-center cohort, the characteristics and perioperative course of patients undergoing surgical diagnosis of MPM. We identified a total of 514 consecutive patients, 71.4% male and 28.6% female, with mean age 71.3 +/- 13.6 years. Most exhibited pleural, respiratory, or general symptoms and American Society of Anesthesiologists (ASA) score was ≥3 in 68.3% of cases. Thoracoscopy was the most frequent approach (92.0%) and short open thoracotomy was performed in the remaining patients. Pleurodesis was simultaneously performed in 74.3% of cases. Diagnostic failure led to redo surgery in 3.7% of patients. Non-epithelioid histology was found in 19.5% of MPMs and was significantly more frequent in right-sided MPM (p = 0.04), and in patients without history of cancer (p = 0.03), or pleural nodules at thoracoscopy (p = 0.01). Minor only or major complications occurred in respectively 7.8% and 3.6% of cases. They were more frequent in patients ≥ 70 years (p = 0.05) and Performance Status > 2 (p = 0.05). The mean hospital stay was 7.5 days. The 30-day and 90-day early mortality rates were 2.3% and 6.4%, respectively. Surgical diagnosis of MPM is a reliable procedure but is associated with significant morbidity and hospital-stay duration.

In plain English

This brief report from a thoracic surgery department at Cochin Hospital in Paris reviewed 514 consecutive patients who had surgery between 2000 and 2020 to diagnose malignant pleural mesothelioma. Patients were 367 men and 147 women, with a mean age of 71.3 years. Asbestos exposure was identified in 236 of them (46.0%). Tissue was taken by thoracoscopy in 92.0% of cases and by a short open operation in the rest. Nineteen patients (3.7%) needed repeat surgery because diagnosis failed or too little tissue was obtained. Non-epithelioid tumors (19.5%) were more frequent in right-sided tumors, in patients with no cancer history, and in patients without pleural nodules. Only minor complications occurred in 41 patients (7.8%) and major ones in 19 (3.6%). Complications were linked to age 70 or older and to poor performance status. Mean hospital stay was 7.5 days. Mortality was 2.3% at 30 days and 6.4% at 90 days. Asbestos exposure was not statistically linked to complications or hospital stay. The authors concluded that surgical diagnosis carries significant morbidity and hospital-stay duration.

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: Retrospective review of a single-center patient series (brief report)
• Who was studied: 514 consecutive patients (367 men, 147 women; mean age 71.3 years) who had surgery to diagnose pathologically proven malignant pleural mesothelioma in a thoracic surgery department at Cochin Hospital, Paris, from 2000 to 2020
• Exposure: The study examined diagnostic surgery, not asbestos. Identified asbestos exposure was recorded as a patient characteristic: 236 of 514 patients (46.0%). No fiber types or doses are given.
• Main results:
  • Biopsies were obtained by thoracoscopy in 92.0% of interventions (n = 473) and by short open thoracotomy in the remaining 41 patients (8.0%)
  • Chemical pleurodesis was performed during thoracoscopic exploration in 74.3% of cases
  • 19 patients (3.7%) required redo surgery for diagnostic failure or insufficient tumor-tissue sampling
  • Non-epithelioid histology was found in 19.5% of tumors. It was significantly more frequent in right-sided tumors (p = 0.04), in patients without a history of cancer (p = 0.03), and in relation to pleural nodules at thoracoscopy (p = 0.01). The discussion describes this as an association with absence of nodules.
  • Of all patients, 455 (88.6%) had an uneventful early postoperative course. Only minor complications occurred in 41 (7.8%) and major complications in 19 (3.6%).
  • Performance Status greater than 2 (p = 0.05) and age 70 years or older (p = 0.05) were associated with higher morbidity after surgery
  • Left-sided tumors showed a trend toward more complications than right-sided ones (13.5% versus 8.9%, p = 0.08). This trend was not statistically significant.
  • Early mortality was 2.3% at 30 days and 6.4% at 90 days
  • Mean hospital stay was 7.5 plus or minus 5.0 days (range 1 to 27)
  • In univariate analysis, hospital stay was significantly longer in patients with any of the following: Performance Status greater than 2, cT parameter 3 or higher, higher white blood cell count, or higher platelet count
  • Asbestos exposure, gender, tobacco consumption, body mass index, history of cancer and respiratory symptoms were not statistically correlated with morbidity or day of hospital discharge
  • During 2010 to 2020, 45 of 344 patients (13.1%) were readmitted for indwelling pleural catheter insertion
• The authors' conclusion: The authors concluded that surgical diagnosis of malignant pleural mesothelioma is a primary step in disease management, allowing pleurodesis where needed. They also concluded that it is associated with significant morbidity and hospital-stay duration, and should be weighed against alternative strategies.
• Limitations the authors state:
  • The readmission rate for permanent pleural drainage is probably underestimated, because some patients were likely treated at other institutions
  • The study was not designed to evaluate the diagnostic sensitivity and specificity of surgical biopsy, nor to compare it with less-invasive techniques

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Thoracoscopy, Thoracotomy, Pleurodesis, Non-epithelioid, Histology, Performance Status.

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