Surgical staging and resection of malignant pleural mesothelioma

Our plain-English summary of Surgical staging and resection of malignant pleural mesothelioma, by L.B. Brown, F. Corl, S.H. Blackmon (Journal of Thoracic Disease, 2020).

The study

• Authors: L.B. Brown, F. Corl, S.H. Blackmon
• Journal: Journal of Thoracic Disease
• Published: 2020;12(12):7467-7480
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This article is a surgical technique paper, not a study of patients. It was built around a medical illustrator's drawings, and no human subjects were used. The authors described how malignant pleural mesothelioma is staged and surgically removed. They covered CT and PET imaging, ultrasound-guided lymph node sampling, and three staging operations: thoracoscopy, laparoscopy and mediastinoscopy. They reproduced the TNM staging definitions from the eighth edition of the American Joint Committee on Cancer manual. They also gave plain-language stage descriptions for discussing treatment with patients. Two operations were described. Pleurectomy and decortication keeps the lung. Extrapleural pneumonectomy removes it. For the risks of each, the authors drew on other published sources. The authors cautioned against placing talc in the chest before staging and review by an expert team, and recommended enrolling eligible patients in clinical trials. No asbestos exposure was studied, but the authors wrote that a history of significant exposure to asbestos, shipyards or construction, with a pleural effusion, should raise suspicion of mesothelioma. They noted that many early staging systems were not externally validated.

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: Surgical technique article (illustrated description of staging and operative procedures); not a study of patients
• Who was studied: No patients or human subjects; the figures were drawings by a medical illustrator
• Exposure: No exposure was studied. The authors wrote that a history of significant exposure to asbestos, shipyards or construction, together with a pleural effusion, should raise suspicion of mesothelioma and change how the effusion is drained and evaluated
• Main results:
  • The article described three surgical staging procedures (mediastinoscopy, laparoscopy and thoracoscopy) used to assess whether a patient is a candidate for surgery
  • The staging tables were taken from the AJCC Cancer Staging Manual, eighth edition, not developed by the authors
  • Citing published guidelines, the article stated that surgery should be reserved for patients in good general condition with stage I to III disease
  • Citing other sources, the article stated that pleurectomy and decortication should be the first choice for early-stage disease
  • The authors warned that talc should not be placed until the patient has been staged and evaluated by an expert team, because it can limit later treatment options
  • In a pitfalls section, the authors noted that management remains controversial and that many early staging systems were based on single-institution experience and not externally validated
• The authors' conclusion: The article has no formal conclusion. The authors recommended that eligible patients be enrolled in clinical trials to answer open questions about this rare disease

Topics

Medical terms in this study, explained in our Lexicon: Staging, Pleural Mesothelioma.

Related studies

• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)
• Improving surgical resection rate in lung cancer — C. Laroche, F. Wells, et al. (1998)
• Survival by Histologic Subtype of Malignant Pleural Mesothelioma and the Impact of Surgical Resection on Overall Survival — V. Verma, C.A. Ahern, et al. (2018)
• Treatment of malignant pleural mesothelioma with chemotherapy preceding versus after surgical resection — V. Verma, C.A. Ahern, et al. (2019)
• Primary malignant pericardial mesothelioma with increased serum mesothelin diagnosed by surgical pericardial resection: A case report — T. Kurosawa, K. Sugino, et al. (2016)
• 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)

Browse more research in Journal of Thoracic Disease, or return to medical research.