Surgical Options for Malignant Mesothelioma: A Single-Center Experience

Our plain-English summary of Surgical Options for Malignant Mesothelioma: A Single-Center Experience, by S.R. Kang, J.S. Bok, G.D. Lee, et al (The Korean Journal of Thoracic and Cardiovascular Surgery, 2018).

The study

• Authors: S.R. Kang, J.S. Bok, G.D. Lee, S.H. Choi, H.R. Kim, D.K. Kim, S.I. Park, Y.H. Kim
• Journal: The Korean Journal of Thoracic and Cardiovascular Surgery
• Published: 2018;51(3):195-201
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: We investigated the surgical outcomes of patients who underwent therapeutic surgery for malignant pleural mesothelioma (MPM) at a single center.

Methods: A retrospective review of 21 patients who underwent therapeutic surgery for MPM from January 2001 to June 2015 was conducted to assess their outcomes. The patients' characteristics and postoperative course, including complications, mortality, overall survival, and recurrence-free survival, were analyzed.

Results: Of the 21 patients who underwent therapeutic surgery, 15 (71.4%) underwent extrapleural pneumonectomy, 2 pleurectomy (9.5%), and 4 excision (19.1 %). The median age was 57 years (range, 32-79 years) and 15 were men (71.4%). The mean hospital stay was 16 days (range, 1-63 days). Median survival was 14.3 months. The survival rate was 54.2%, 35.6%, and 21.3% at 1, 3, and 5 years, respectively. In patients' postoperative course, heart failure was a major complication, occurring in 3 patients (14.3%). The in-hospital mortality rate was 2 of 21 (9.5%) due to a case of severe pneumonia and a case of acute heart failure.

Conclusion: A fair 5-year survival rate of 21.3% was observed after surgical treatment. Heart failure was a major complication in our cohort. Various surgical methods can be utilized with MPM, each with its own benefits, taking into consideration the severity of the disease and the comorbidities of the patient. Patients with local recurrence may be candidates for surgical intervention, with possible satisfying results.

In plain English

This study reviewed records of 21 patients who had surgery for malignant pleural mesothelioma at one hospital in Seoul, Korea, from January 2001 to June 2015. Fifteen had extrapleural pneumonectomy (removal of the lung and surrounding tissues), 2 pleurectomy and 4 excision. Six of the 21 patients (28.6%) were recorded as exposed to asbestos. No fiber types or exposure details were given. After surgery, 7 of 21 (33.3%) had complications, most often heart failure (3 of 21). Two patients died in hospital, one from cardiac arrest due to acute right ventricular failure and one from pneumonia. Median survival was 14.3 months. Survival was 54.2% at 1 year, 35.6% at 3 years and 21.3% at 5 years. Of 12 recurrences, 8 were local. Survival differed by operation type, but not statistically significantly (p=0.595). One patient's lymph-node recurrence was removed, followed by 9 cycles of cisplatin and pemetrexed chemotherapy; 7 years later this patient showed no symptoms or signs of recurrence. The authors concluded that their data were not conclusive because of the small number of cases. The article contains several internal number inconsistencies.

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 medical records of surgical patients at a single institution (case series)
• Who was studied: 21 patients who underwent surgical treatment for malignant pleural mesothelioma at Asan Medical Center, Seoul, Korea, from January 2001 to June 2015; 15 men and 6 women, aged 32 to 79
• Exposure: The study examined surgical treatments: extrapleural pneumonectomy in 15 (71.4%), pleurectomy in 2 (9.5%) and excision in 4 (19.1%). Asbestos exposure was recorded in 6 of 21 patients (28.6%). No fiber types, jobs or doses are given.
• Main results:
  • Asbestos exposure was recorded in 6 of the 21 patients (28.6%).
  • Postoperative complications occurred in 7 of 21 patients (33.3%). Heart failure was the most common, in 3 of 21 (14.3%).
  • Two of 21 patients (9.5%) died in hospital: one from sudden cardiac arrest due to acute right ventricular failure on the day of surgery, and one from postoperative bacterial pneumonia.
  • In the whole cohort of 21, median survival was 14.3 months.
  • In the whole cohort, survival was 54.2% at 1 year, 35.6% at 3 years and 21.3% at 5 years.
  • When patients who died within 90 days were excluded, median overall survival was 29.0 months.
  • Median recurrence-free survival in the whole cohort was 11.8 months.
  • Among the 12 recurrences, 8 were local, 2 were distant and 2 were both local and distant.
  • Survival rates by operation type were 43.6% for pleurectomy, 34.9% for excision and 17.5% for extrapleural pneumonectomy. The difference was not statistically significant (p=0.595).
  • Three patients had R1 resection (incomplete removal). The text says they had a worse outcome, but the figure comparing survival by completeness of resection gives p=0.826.
  • Apart from patient #1, all in-hospital deaths and complications occurred in patients who had extrapleural pneumonectomy.
  • One patient (#15) had pleurectomy with chest wall resection. A lymph node recurrence 3 months later was surgically removed and followed by 9 cycles of cisplatin and pemetrexed. After 7 years this patient was still in outpatient follow-up without symptoms or signs of recurrence (a single case).
• The authors' conclusion: The authors concluded that heart failure was a major complication in their cohort, and that their data did not yield conclusive outcomes because of the small number of cases. They wrote that they had illustrated various forms of surgical management. They said a larger study is warranted, and that patients with local recurrence may be candidates for surgery.
• Limitations the authors state:
  • There were too few patients to show which operation gives the most benefit against the cancer.
  • The small number of cases meant the data did not yield conclusive outcomes.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Overall Survival, Recurrence-Free Survival, Extrapleural Pneumonectomy (EPP), Median Overall Survival.

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• Single-Center 20-Year Experience in Surgical Treatment of Malignant Pleural Mesothelioma — G. Mangiameli, E. Bottoni, et al. (2022)
• Should we continue to offer extrapleural pneumonectomy to selected mesothelioma patients? A single center experience comparing surgical and non-surgical management — M. Baud, A. Bobbio, et al. (2014)
• Extensive surgical resections for rare pleural neoplasms: a single-center experience with a yolk sac tumor and synovial sarcoma — T. Vandaele, J. Van Slambrouck, et al. (2024)
• Surgical Diagnosis of Malignant Pleural Mesothelioma: 20 Years' Experience at a High-Volume Referral Center — A. Iaffaldano, T. Charrier, et al. (2021)
• Immunohistochemistry in Peritoneal Mesothelioma: A Single-Center Experience of 244 Cases — R.T. Tandon, Y. Jimenez-Cortez, et al. (2018)
• Utility of CEA and CA 15-3 measurements in non-purulent pleural exudates in the diagnosis of malignancy: A single-center experience — J.M. Porcel, C. Civit, et al. (2017)

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