Metastatic Risk After Diagnostic Surgery
Although surgery is often used to confirm a mesothelioma diagnosis, certain post-operative developments can complicate the procedure. Metastases to the chest tract is one of the most common and dangerous complications.
In a previous study from Kyoto University in Japan, metastatic spread to the site of the surgery was found to be a significant risk for malignant mesothelioma patients who underwent chest instrumentation for diagnosis.
The study examined 14 pleural mesothelioma patients who had undergone chest wall intervention as a means of diagnosing their disease. These operations were conducted between 2006 and 2010. Seven of these patients also underwent an extrapleural pneumonectomy to remove the cancerous lung.
Of the seven patients, two displayed metastatic spread to the chest wall tract where an incision had been made for the surgery. Histological confirmation was obtained to verify the metastasis.
In one of the patients with metastatic seeding, the tumor progressed to the intercostal muscle, while the other patient’s tumors extended along the entire intervention tract to the bottom of the derma. The first patient who experienced the metastatic spread died from a peritoneal recurrence of mesothelioma three months after the surgery. The other patient received adjuvant chemotherapy and intensity modulated radiation therapy, but he passed away when the cancer recurred in his peritoneum 10 months later.
Occasionally fatal, this metastasis can occur after a pleural aspiration, pleural biopsy or thoracoscopy. The malignant seeding follows the entry path of the needle or other surgical instrument and leads to subcutaneous nodule formation. This metastasis can be quite aggressive and may also affect other spaces adjacent to the chest wall tract.
To reduce the risk of metastasis, preventative radiation is often offered to patients who can withstand the treatment. Some surgeons also recommend resection of the chest wall tract during an extrapleural pneumonectomy to eliminate the possibility of a cancerous recurrence.