One form of treatment offered to mesothelioma patients is resection surgery. This is an operation where surgeons try to remove as much of the cancerous tissue as possible. Removing tumours helps to alleviate symptoms and prolong life expectancy.
Before undertaking surgery, a patient will have had x-rays and scans so that doctors have as much information about the cancer as possible before they get into the operating theatre. However, there are times when the full picture is not apparent until the patient has been opened up on the operating table.
In some cases, it is only during the operation that it becomes clear that resection surgery is not possible. By this time, the patient is already under a general anaesthetic and has a large wound down their chest but their tumour cannot be removed.
Diffuse chest wall invasion
A common reason for a surgeon not being able to carry out the surgery is diffuse chest wall invasion (DCWI).
In patients with DCWI the mesothelioma has spread to the chest wall. When this happens and the tumour is widespread, it is difficult to pick up on x-rays or scans and so it is not until during a resecting operation that this is discovered.
If DCWI is found, the tumour cannot be resected and the patient has to be closed up and an alternative treatment pursued. This can result in a loss of valuable treatment time and the patient is left with a wound that needs to heal, without having the benefits the surgery promised.
Non-invasive identification of DCWI
Researchers at Baylor have carried out a retrospective study in the hope of being able to identify DCWI in a non-invasive way.
They reviewed 170 patients undergoing complete pleural resection for pleural mesothelioma between 2014 and 2018. In 104 of the patients, complete resection was achieved through pleurectomy/decortication and in 39 patients, complete resection was achieved through extrapleural pneumonectomy.
In 27 patients, unresectable disease was found at thoracotomy and in 3 patients by intrathoracic organ invasion.
In 24 patients, equating to 14% of those studied, resection was not possible due to DCWI.
The researchers looked at variables that might have some bearing on DCWI to see if they were measurable.
Thoracic cage volume
They found that they could measure the thoracic cage volume of patients through a CT scan and that this related to DCWI.
Bryan Burt, the study’s author said, “In univariable analysis, decreased ipsilateral thoracic cage volume demonstrated the strongest association with unresectability by DCWI.”
It was found that patients with more than a 5% decrease in their thoracic cage volume were most likely to be inoperable.
This is extremely important research. Mesothelioma patients do not have the strength or time to undergo operations without any guarantee of the surgery being completed. To have a measurable entity that can help predict whether their surgery will be possible is a huge benefit.
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Burt, B, et al, “Preoperative prediction of unresectability in malignant pleural mesothelioma”, November 27, 2019, Journal of Thoracic and Cardiovascular Surgery, Epub ahead of print, https://www.jtcvs.org/article/S0022-5223(19)33489-0/abstract