Contemporary issues in the surgical management of pleural mesothelioma

Paajanen, Juuso; Jaklitsch, Michael T.; Bueno, Raphael

doi:10.1002/jso.27152

Cited by 3 publications

(3 citation statements)

References 102 publications

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“…Our institution's standardized preoperative work‐up and surgical approach has recently been reviewed elsewhere. 20 Operative details were gathered directly from surgeon surveys or from operation notes. Clinical and pathological data collected included age, sex, histological subtype, extent of the resection, and tumor laterality.…”

Section: Methodsmentioning

confidence: 99%

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Circulating SMRP and CA‐125 before and after pleurectomy decortication for pleural mesothelioma

Paajanen,

Sadek,

Richards

et al. 2024

Thoracic Cancer

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BackgroundTumor recurrence remains the main barrier to survival after surgery for pleural mesothelioma (PM). Soluble mesothelin‐related protein (SMRP) and cancer antigen 125 (CA‐125) are established blood‐based biomarkers for monitoring PM. We prospectively studied the utility of these biomarkers after pleurectomy decortication (PD).MethodsPatients who underwent PD and achieved complete macroscopic resection with available preoperative SMRP levels were included. Tumor marker levels were determined within 60 days of three timepoints: (1) preoperation, (2) post‐operation, and (3) recurrence.ResultsOf 356 evaluable patients, 276 (78%) had recurrence by the end of follow‐up interval. Elevated preoperative SMRP levels were associated with epithelioid histology (p < 0.013), advanced TNM (p < 0.001) stage, and clinical stage (p < 0.001). Preoperative CA‐125 levels were not significantly associated with clinical covariates. Neither biomarker was associated with survival or disease‐free survival. With respect to nonpleural and nonlymphatic recurrences, mean SMRP levels were elevated in patients with pleural (p = 0.021) and lymph node (p = 0.042) recurrences. CA‐125 levels were significantly higher in patients with abdominal (p < 0.001) and lymph node (p = 0.004) recurrences. Among patients with all three timepoints available, we observed an average decrease in SMRP levels by 1.93 nmol/L (p < 0.001) postoperatively and again an average increase at recurrence by 0.79 nmol/L (p < 0.001). There were no significant changes in levels of CA‐125 across the study timepoints (p = 0.47).ConclusionsLongitudinal changes in SMRP levels corresponded with a radiographic presence of disease in a subset of patients. SMRP surveillance could aid in detection of local recurrences, whereas CA‐125 could be helpful in recognizing abdominal recurrences.

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Section: Methodsmentioning

confidence: 99%

“…Our institution's standardized preoperative work‐up and surgical approach has recently been reviewed elsewhere 20 . Operative details were gathered directly from surgeon surveys or from operation notes.…”

Section: Methodsmentioning

confidence: 99%

Circulating SMRP and CA‐125 before and after pleurectomy decortication for pleural mesothelioma

Paajanen,

Sadek,

Richards

et al. 2024

Thoracic Cancer

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“…In fact, both are associated with substantial morbidity and mortality rates, as high as 31% in extrapleural pneumonectomy [ 204 ]. Surgery as a standalone treatment, therefore, cannot be recommended in MPM, but novel approaches using multimodality intervention (surgery, radiotherapy, chemotherapy and immunotherapy) remain under investigation [ 205 ].…”

Section: Managementmentioning

confidence: 99%

Malignant pleural disease

Piggott,

Hayes,

Greene

et al. 2023

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Malignant pleural disease represents a growing healthcare burden. Malignant pleural effusion affects approximately 1 million people globally per year, causes disabling breathlessness and indicates a shortened life expectancy. Timely diagnosis is imperative to relieve symptoms and optimise quality of life, and should give consideration to individual patient factors. This review aims to provide an overview of epidemiology, pathogenesis and suggested diagnostic pathways in malignant pleural disease, to outline management options for malignant pleural effusion and malignant pleural mesothelioma, highlighting the need for a holistic approach, and to discuss potential challenges including non-expandable lung and septated effusions.

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