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Original Articles: General Thoracic

Second Surgery for Recurrence of Malignant Pleural Mesothelioma After Extrapleural Pneumonectomy

^a Department of Medical and Surgical Critical Care, University of Florence, Florence
^b Department of Surgery, University of Verona, Verona, Italy

Accepted for publication September 14, 2009.

^_* Address correspondence to Dr Politi, Department of Medical and Surgical Critical Care, Azienda Ospedaliero Universitaria Careggi, Viale Morgagni 85, Firenze, I-50134, Italy (Email: leonardo.politi{at}unifi.it).

Background: Extrapleural pneumonectomy is a treatment option for malignant pleural mesothelioma (MPM), but disease recurrence is common. Among different therapeutic options for recurrence, we have found no reports for second surgical procedures.

Methods: We retrospectively evaluated the types and outcomes of surgical management of solid recurrences of MPM, in a series of 74 patients treated with extrapleural pneumonectomy over a 20-year period.

Results: Of 57 patients for whom follow-up data were available, 11 patients experienced recurrent disease in the form of a solid mass, 1.5 to 12 years after the initial treatment; 8 of these patients had sufficiently good clinical conditions to undergo a second surgery with curative intent. Chest wall resection was performed in 4 cases of parietal recurrence, radical retroperitoneal resection was done in 3 cases of retroperitoneal relapse, and segmental resection of the remaining lung was done in one case of pulmonary metastasis. In this latter case, although computed tomographic images showed a solid mass, at surgery the disease was found to have a serosal nature, precluding the possibility of a curative surgery. Median survival after the second surgery was 14.5 months (range, 6 to 29); no association between survival and site of recurrence, age or disease-free interval was found.

Conclusions: In this series, the second surgery did not offer the expected survival benefit of curative treatment strategies and should therefore be considered palliative. Second surgery may be a treatment option in a subset of patients who experience a solid recurrence of MPM that is symptomatic or near vital organs and who cannot undergo additional radiotherapy.

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Invited Commentary

David Rice
Ann. Thorac. Surg. 2010 89: 210-211. [Extract] [Full Text] [PDF]

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				D. Rice Invited Commentary Ann. Thorac. Surg., January 1, 2010; 89(1): 210 - 211. [Full Text] [PDF]