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.
1. Introduction
Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy with a poor prognosis, principally caused by a prior asbestos exposure. To date, the multimodal approach, including chemotherapy (CT) and surgery, with or without radiotherapy (RT), with curative intent represents the gold standard therapy for selected patients (early-stage disease with epithelioid histology). For resectable disease, the main surgical procedures consist of extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D), performed in order to achieve a macroscopic complete resection. Although there are no randomised comparisons between the two aforementioned techniques, the literature’s data promote the P/D as a less invasive technique with comparable outcomes, but it is still unclear which is better in terms of survival and control of the disease. Local and/or distant failure is one of the major issues; in fact, there has been no validated treatment for relapsed MPM after the multimodal protocol and, as far as we known, limited evidence exists concerning the post-recurrence outcomes after the multimodal treatment. In this scenario, the aim of this systematic review is to provide a comprehensive view of this subject that explores if a second surgery leads to improvement in survival.
[Article continues at original source]
Asbestos & Mesothelioma Information
Asbestos-Mesothelioma Case Evaluation
Free. Confidential. No Obligation