Department of Cardiothoracic Surgery, Stanford University Medical School, Stanford, Calif.
J Thorac Cardiovasc Surg. 2013 Dec;146(6):1373-9; discussion 1379-80. doi: 10.1016/j.jtcvs.2013.07.012. Epub 2013 Oct 8.
The ipsilateral hemithorax is the most common site of recurrence after surgical resection for malignant pleural mesothelioma. Salvage treatment has generally been ineffective. We reviewed the outcomes after resection of isolated ipsilateral chest recurrence after cytoreductive surgery in patients with malignant pleural mesothelioma.
Patients with malignant pleural mesothelioma who underwent initial surgical resection at our institution from 1988 to 2011 and were subsequently treated for localized recurrence with an additional chest resection were identified and their data retrospectively reviewed.
A total of 1142 patients underwent either extrapleural pneumonectomy (n = 794) or pleurectomy/decortication (n = 348). Of the patients who returned for follow-up, 47 (4.1%) had chest wall recurrence amenable to resection. The location of recurrence was predominantly incisional (49%) and/or costophrenic (38%). The median time to recurrence after either extrapleural pneumonectomy or pleurectomy/decortication was 16.1 months (range, 2.7-58.2). No 30-day mortality was found for chest wall resection, and the median length of stay in the hospital was 3 days (range, 0-12). The median overall survival duration after chest wall resection correlated positively with the time to recurrence (epithelial: median, 8.9, 17.2, and 35.8 months for a time to recurrence of <12, 12 to <24, and ≥24 months, respectively; biphasic: median, 2.7 and 15.9 months for a time to recurrence of <10 and ≥10 months, respectively).
Chest wall resection is a safe and effective therapeutic option in the management of localized chest wall recurrence of malignant pleural mesothelioma. The time to recurrence appears to be predictive of the expected survival benefit in both epithelial and biphasic malignant pleural mesothelioma.
在因恶性胸膜间皮瘤接受手术切除后的复发中，同侧胸腔是最常见的部位。挽救性治疗通常效果不佳。我们回顾了在接受细胞减灭术治疗后的恶性胸膜间皮瘤患者中，孤立性同侧胸腔复发后行切除术的治疗结果。
我们在机构中对 1988 年至 2011 年期间接受初次手术切除且随后因局限性复发接受额外胸部切除术的恶性胸膜间皮瘤患者进行识别，并回顾性地分析其数据。
共有 1142 例患者接受了胸膜外全肺切除术（n=794）或胸膜切除术/剥脱术（n=348）。在返回随访的患者中，47 例（4.1%）存在可切除的胸壁复发。复发的位置主要是切口部位（49%）和/或肋膈角部位（38%）。胸膜外全肺切除术或胸膜切除术/剥脱术后复发的中位时间为 16.1 个月（范围，2.7-58.2）。胸壁切除术未发现 30 天死亡率，住院中位时间为 3 天（范围，0-12）。胸壁切除后的中位总生存时间与复发时间呈正相关（上皮型：复发时间<12、12-<24 和≥24 个月的中位总生存时间分别为 8.9、17.2 和 35.8 个月；双相型：复发时间<10 和≥10 个月的中位总生存时间分别为 2.7 和 15.9 个月）。
胸壁切除术是治疗恶性胸膜间皮瘤局限性胸壁复发的一种安全有效的治疗选择。复发时间似乎可预测上皮型和双相型恶性胸膜间皮瘤的预期生存获益。
