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Bellini A, Mazzarra S, Sterrantino S, Argnani D, Stella F. Second Surgery for Recurrent Malignant Pleural Mesothelioma after Multimodality Treatment: A Systematic Review. J Clin Med 2022; 11:jcm11123340. [PMID: 35743417 PMCID: PMC9225173 DOI: 10.3390/jcm11123340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive asbestos-related tumour with poor prognosis. To date, a multimodality treatment, including chemotherapy and surgery, with or without radiotherapy, is the gold standard therapy for selected patients with epithelioid and early-stage MPM. In this setting, the goal of surgery is to achieve the macroscopic complete resection, obtained by either extrapleural pneumonectomy or pleurectomy/decortication. Failure, in local and/or distant sites, is one of the major concerns; in fact, there has been no established treatment for the recurrence of MPM after the multimodal approach, and the role of surgery in this context is still controversial. By using electronic databases, studies that included recurrent MPM patients who underwent a second surgery were identified. The endpoints included were: a pattern of recurrence, post-recurrence survival (PRS), and the type of second surgery. When available, factors predicting better PRS and perioperative mortality and morbidity were collected. This systematic review offers an overview of the results that are currently obtained in patients undergoing a second surgery for relapsed MPM, with the aim to provide a comprehensive view on this subject that explores if a second surgery leads to an improvement in survival.
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Affiliation(s)
- Alice Bellini
- Department of Surgery, Division of Thoracic Surgery, G.B. Morgagni—L. Pierantoni Hospital, Via Carlo Forlanini n.34, 47121 Forlì, Italy; (S.M.); (S.S.); (D.A.); (F.S.)
- Correspondence: ; Tel.: +39-0543-735650
| | - Sara Mazzarra
- Department of Surgery, Division of Thoracic Surgery, G.B. Morgagni—L. Pierantoni Hospital, Via Carlo Forlanini n.34, 47121 Forlì, Italy; (S.M.); (S.S.); (D.A.); (F.S.)
| | - Sara Sterrantino
- Department of Surgery, Division of Thoracic Surgery, G.B. Morgagni—L. Pierantoni Hospital, Via Carlo Forlanini n.34, 47121 Forlì, Italy; (S.M.); (S.S.); (D.A.); (F.S.)
| | - Desideria Argnani
- Department of Surgery, Division of Thoracic Surgery, G.B. Morgagni—L. Pierantoni Hospital, Via Carlo Forlanini n.34, 47121 Forlì, Italy; (S.M.); (S.S.); (D.A.); (F.S.)
| | - Franco Stella
- Department of Surgery, Division of Thoracic Surgery, G.B. Morgagni—L. Pierantoni Hospital, Via Carlo Forlanini n.34, 47121 Forlì, Italy; (S.M.); (S.S.); (D.A.); (F.S.)
- Department of Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, Division of Thoracic Surgery, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, via Carlo Forlanini n. 34, 47121 Forlì, Italy
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Drug Regimen for Patients after a Pneumonectomy. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor1020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pneumonectomy is an entire lung removal and is indicated for both malignant and benign diseases. Due to its invasiveness and postoperative complications, pneumonectomy is still associated with high mortality and morbidity. Appropriate postoperative management is crucial in pneumonectomy patients to improve quality of life and overall survival rates. Diverse drug regimens are under development to be used in adjuvant chemotherapy or to improve respiratory health after a pneumonectomy. The most common causes for a pneumonectomy are non-small cell lung cancer, malignant pleural mesothelioma, and tuberculosis; thus, an appropriate drug regimen is necessary. The uncommon incidence of pneumonectomy cases remains the major obstacle in studies of postoperative drug regimens. As the majority of current studies include post-lobectomy and post-segmentectomy patients, it is highly recommended that further research of postoperative drug regimens be focused on post-pneumonectomy patients.
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Bellini A, Dell’Amore A, Terzi S, Zambello G, Zuin A, Pasello G, Calabrese F, Schiavon M, Rea F. Relapse Patterns and Tailored Treatment Strategies for Malignant Pleural Mesothelioma Recurrence after Multimodality Therapy. J Clin Med 2021; 10:jcm10051134. [PMID: 33800433 PMCID: PMC7962831 DOI: 10.3390/jcm10051134] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 12/31/2022] Open
Abstract
To date, there have been no established therapies for recurrent malignant pleural mesothelioma (MPM) after multimodality treatment. Aims of this retrospective study are to analyze the recurrence pattern, its treatment and to identify the predictors of best oncological outcomes for relapsed MPM, comparing extrapleural pneumonectomy (EPP) vs. pleurectomy/decortication (PD). Study population: 94 patients with recurrence of MPM after multimodality treatment underwent macroscopic complete resection (52.1% with EPP and 47.9% with PD) between July 1994 and February 2020. Distant spread was the most frequent pattern of recurrence (71.3%), mostly in the EPP group, while the PD group showed a higher local-only failure rate. Post-recurrence treatment was administered in 86.2%, whereas best supportive care was administered in 13.8%. Median post-recurrence survival (PRS) was 12 months (EPP 14 vs. PD 8 months, p = 0.4338). At multivariate analysis, predictors of best PRS were epithelial histology (p = 0.026, HR 0.491, IC95% 0.263–0.916), local failure (p = 0.027, HR 0.707, IC95% 0.521–0.961), DFS ≥ 12 months (p = 0.006, HR 0.298, IC95% 0.137–0.812) and post-recurrence medical treatment (p = 0.046, HR 0.101, IC95% 0.897–0.936). The type of surgical intervention seems not to influence the PRS if patients are fit enough to face post-recurrence treatments. In patients with a prolonged disease-free interval, in the case of recurrence the most appropriate treatment seems to be the systemic medical therapy, even in the case of local-only relapse.
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Affiliation(s)
- Alice Bellini
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
| | - Andrea Dell’Amore
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
- Correspondence: ; Tel.: +49-821-22-42; Fax: +49-821-22-20
| | - Stefano Terzi
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
| | - Giovanni Zambello
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
| | - Andrea Zuin
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
| | - Giulia Pasello
- Medical Oncology, Veneto Institute of Oncology IOV IRCCS, 35128 Padova, Italy;
| | - Fiorella Calabrese
- Pathology Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy;
| | - Marco Schiavon
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
| | - Federico Rea
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
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Bellini A, Dell'Amore A, Ferrigno P, Sella N, Navalesi P, Rea F. ECLS for Life-Threatening Complications in Mesothelioma's Surgery: Is It Worthwhile? Thorac Cardiovasc Surg 2021; 69:548-550. [PMID: 33601471 DOI: 10.1055/s-0041-1724037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Extracorporeal life support (ECLS) is an effective method for bridging patients to recovery in cases of respiratory and/or cardiac failure that are potentially reversible and unresponsive to conventional management. Nevertheless, there have been only few reports about the use of ECLS in oncological patients with complications due to their neoplasm or its treatment. We report the use of veno-arterial extracorporeal membrane oxygenation in three cases of severe perioperative complications following surgery for mesothelioma after induction chemotherapy at our Institution.
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Affiliation(s)
- Alice Bellini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Thoracic Surgery Unit, Padova University Hospital, Padova, Italy
| | - Andrea Dell'Amore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Thoracic Surgery Unit, Padova University Hospital, Padova, Italy
| | - Pia Ferrigno
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Thoracic Surgery Unit, Padova University Hospital, Padova, Italy
| | - Nicolo' Sella
- Department of Medicine - DIMED, Padova University Hospital, Padova, Italy
| | - Paolo Navalesi
- Department of Medicine - DIMED, Padova University Hospital, Padova, Italy.,Institute of Anesthesia and Intensive Care, Padova University Hospital, Padova, Italy
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Thoracic Surgery Unit, Padova University Hospital, Padova, Italy
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Faccioli E, Bellini A, Mammana M, Monaci N, Schiavon M, Rea F. Extrapleural pneumonectomies for pleural mesothelioma. Expert Rev Respir Med 2019; 14:67-79. [PMID: 31674841 DOI: 10.1080/17476348.2020.1688147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Malignant pleural mesothelioma (MPM) is a fatal malignancy for which there is no definitive cure. The most effective multimodality treatment in prolonging survival is still matter of debate. Surgery remains one of the cornerstones in the multimodality therapy for MPM. Extra-pleural pneumonectomy and pleurectomy/decortication are the two main curative-intent procedures; however, the superiority of one technique over the other is still debated. This review aims to assess short- and long-term results of extrapleural pneumonectomy for MPM.Areas covered: This article focuses on the role of extrapleural pneumonectomy in MPM. A systematic review was performed by using electronic databases to identify studies that included patients treated by this procedure for MPM. Endpoints included overall survival, disease-free survival, recurrence rate, perioperative mortality, and morbidity.Expert commentary: This paper offers an overview of the results that are currently obtained in patients undergoing extrapleural pneumonectomy for MPM. The benefit of surgical treatments in MPM is still debated and its primary goal should be the achievement of a macroscopic complete resection. Several alternative multimodality protocols exist, with specific advantages and drawbacks; therefore, individualization of care for each patient is fundamental. The complexity of the surgical treatment mandates that patients be referred to specialized centers.
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Affiliation(s)
- Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Alice Bellini
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Nicola Monaci
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
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Shohdy K, Abdel-Rahman O. The timing of chemotherapy in the management plan for medically operable early-stage malignant pleural mesothelioma. Expert Rev Respir Med 2019; 13:579-584. [PMID: 30977408 DOI: 10.1080/17476348.2019.1607300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Trimodality therapy (including surgery, chemotherapy and radiation therapy) represents an important management approach of early-stage malignant pleural mesothelioma (MPM). The oncological value, as well as the proper sequence of the three modalities, is still under investigations. Areas Covered: The article covers the timing of chemotherapy in the management plan with either a neoadjuvant approach or adjuvant approach. It evaluates also how to select patients for induction chemotherapy and how to assess the response to treatment. Expert Opinion: Management of patients with early-stage MPM must be completed in a multidisciplinary team in tertiary centers. Availability of newer prognostic and response assessment tools should facilitate the use of induction chemotherapy as well as the selection of patients who might benefit from radical surgery.
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Affiliation(s)
- Kyrillus Shohdy
- a Clinical Oncology Department , Kasr Alainy School of Medicine , Cairo , Egypt
| | - Omar Abdel-Rahman
- b Clinical Oncology Department , Ain Shams University , Cairo , Egypt.,c Department of Oncology , University of Calgary and Tom Baker Cancer Center , Calgary , Canada
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Treatment of malignant pleural mesothelioma with chemotherapy preceding versus after surgical resection. J Thorac Cardiovasc Surg 2019; 157:758-766.e1. [DOI: 10.1016/j.jtcvs.2018.10.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 09/19/2018] [Accepted: 10/08/2018] [Indexed: 11/18/2022]
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Abstract
Malignant pleural mesothelioma (MPM) is a highly aggressive and generally incurable cancer. Current anti-MPM chemotherapy-based treatments are only marginally effective, and long-term survival remains an unmet goal. Nonetheless, in selected cases, personalized surgery-based multimodality treatments (MMT) have been shown to significantly extend survival. The design of MMT and selection of patients are challenging, and optimal results require accurate presurgical diagnosis, staging, and risk stratification. Further, meticulous surgical techniques and advanced radiation protocols must be applied. We review key principles and evolving concepts in the care of MPM patients with a focus on the expanding role of MMT in MPM.
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Affiliation(s)
- Ori Wald
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem 91120, Israel
| | - David J Sugarbaker
- Division of General Thoracic Surgery, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.,Lung Institute, Baylor College of Medicine, Houston, Texas 77030, USA;
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