Mesothelioma Recurrence After PD Surgery

A new study finds that mesothelioma recurrence after PD surgery is common but most patients still live for more than a year afterwards. More than a third were still alive three years after recurrence.

The study included 90 Japanese patients with malignant pleural mesothelioma. 

Those who lived for at least a year without mesothelioma recurrence after PD surgery had the best chance of longer term survival. A good performance status and undergoing additional treatment were also key to better outcomes. 

Understanding Pleurectomy with Decortication (PD) Surgery

Pleural mesothelioma is a virulent cancer that occurs on the membrane around the lungs. There is no cure for mesothelioma. Even with the best treatment, the cancer usually comes back. The goal of most treatments is to extend the time before mesothelioma recurrence. 

PD stands for pleurectomy with decortication. During PD surgery, surgeons remove the diseased pleural membrane. They also remove part of the diaphragm, the membrane around the heart, and other at-risk tissues. No one has ever done a formal study on mesothelioma recurrence after PD surgery. 

PD is a more conservative alternative to extrapleural pneumonectomy (EPP). During EPP, surgeons also remove one of the lungs. 

First Study of Mesothelioma Recurrence After PD Surgery

This first study of mesothelioma recurrence after PD surgery happened at Hyogo College of Medicine. It is a retrospective study. This means that researchers analyzed past patient records. 

The study looked at the records of 90 pleural mesothelioma patients. All of the patients underwent chemotherapy before their surgery. Neoadjuvant chemotherapy aims to shrink the tumor for easier removal. The more complete the resection, the lower the chance of mesothelioma recurrence after PD surgery. 

The cancer came back in 63 percent of the patients. But almost 70 percent of them made it a year before that happened. Thirty-four percent of the mesothelioma patients went a full  3 years before their cancer returned. 

More than three-quarters of the patients had another treatment after surgery, such as radiation or chemotherapy. This was one of the factors that appeared to influence survival in people with mesothelioma recurrence after PD surgery. 

“Multivariate analysis revealed that post-recurrence treatment, performance status 0-1, and disease-free interval of >12 months were the independent, favorable, and significant prognostic factors of post-recurrence survival,” writes lead author Akifumi Nakamura, MD. 

The longer it took for mesothelioma recurrence after PD surgery, the longer a person was likely to live. Fifty-nine percent of patients lived for at least a year after their cancer came back. 

Mesothelioma surgery is not an option for all patients. To be eligible, a patient must have a relatively small tumor and be in otherwise good health.

Source:

Nakamura, A, et al, “Clinical outcomes with recurrence after pleurectomy/decortication for malignant pleural mesothelioma”, January 18, 2020, Annals of Thoracic Surgery, Epub ahead of print, https://www.annalsthoracicsurgery.org/article/S0003-4975(20)30037-0/pdf