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Recurrence Patterns and Management after Pleurectomy Decortication for Pleural Mesothelioma
Juuso Paajanen1,2, William G Richards1, Yue Xie3
1Department of Thoracic Surgery, The Thoracic Surgery Oncology Laboratory and the International Mesothelioma Program, Division of Thoracic Surgery and the Lung Center, Brigham, and Women's Hospital, and Harvard Medical School, Boston, MA.
Annals of Surgery
|January 15, 2025
Summary
Recurrence after pleurectomy decortication for pleural mesothelioma is predominantly local. Repeat surgery can offer good local control for selected patients with recurrent disease.
Area of Science:
- Oncology
- Thoracic Surgery
- Malignant Pleural Mesothelioma Research
Background:
- Tumor recurrence significantly impacts long-term survival following surgical treatment for pleural mesothelioma (PM).
- Understanding recurrence patterns is crucial for improving patient outcomes after pleurectomy decortication (PD).
Purpose of the Study:
- To investigate the primary sites of tumor recurrence after PD in patients with PM.
- To identify factors associated with disease-free interval (DFI) and post-recurrence survival (PRS).
Main Methods:
- Retrospective analysis of 436 patients with diffuse PM who underwent PD between 1998 and 2022.
- Review of postoperative scans to determine the timing and locations of initial tumor recurrence.
- Multivariable analysis to identify predictors of DFI and PRS.
Main Results:
- Local recurrence was the most frequent pattern, observed in 85% of cases (N=370).
- Sarcomatoid tumors showed earlier relapse and more frequent distant spread compared to other subtypes.
- Factors associated with DFI included age, tumor volume, histology, intraoperative chemotherapy, and TNM stage. PRS was influenced by age, performance status, histology, chemotherapy, TNM stage, surgery type, and recurrence number.
Conclusions:
- Pleural mesothelioma frequently recurs locally after PD.
- Repeat surgical resection is a viable option for achieving local control in select patients with recurrent PM.
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