Second Surgery for Recurrent Malignant Pleural Mesothelioma after Multimodality Treatment: A Systematic Review

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.

En bloc resection of the recurrent pleural mesothelioma and reconstruction of the chest wall after immunotherapy: A case report

“…Distant spread and local failure are the common recurrent patterns, and multimodality treatment including radiotherapy and systematic treatment might therefore be suitable for recurrent MPM 8,9 . However, the second surgery might not lead to survival improvement, but could palliate symptoms and provide disease control 6,10 . We are of the opinion that maximal cytoreduction is critical in disease control and might help to improve patient prognosis.…”

“… 8 , 9 However, the second surgery might not lead to survival improvement, but could palliate symptoms and provide disease control. 6 , 10 We are of the opinion that maximal cytoreduction is critical in disease control and might help to improve patient prognosis. Dual immunotherapy (nivolumab and ipilimumab) has previously been associated with significantly improved survival for MPM.…”