How Do You Prevent the Recurrence of Mesothelioma at the Incision Site?

[MUSIC PLAYING] The interesting thing about mesothelioma versus other cancers is that mesothelioma does have a predilection to go towards incision sites. And so two things that you have to do with mesothelioma. One, when you do the surgery, you want to do as few incisions as possible, whether it be the biopsy. So that's why in the biopsy you just want to do one incision. And the ultimate surgery, one big incision in a certain area. And the idea behind all that is that mesothelioma eventually, not right away, but within even as early as two months after surgery, can go to the incision itself. So when you're doing the surgery, you have to make sure that you are very careful about how you do it and that you try to take it out in a way that does not displace other tissue, other incisions, and that it's in a sterile environment. And so part of the way we also prevent recurrences is we use multiple techniques. Some people will use heated chemotherapy. Some people will use heated betadine, other types of chemical agents to actually perfuse and put that into the chest cavity. And we also use laser beam coagulation as well as even scrub brushes. So the idea is that you clean off the area as much as possible around the incision sites that you can. And that when we do all those techniques, we find that 10% to 20% will eventually get a recurrence in their incision. Now what do you do for that? So we do for that, we can either do radiation to that area, which has been shown to be beneficial. But usually, they're just in the incision. And they're not spread. It's not distance spread. So when you do mesothelioma surgery, you may think that it spreads everywhere. But it's already in the mesothelial lining. It already is everywhere. We take all that out. So there's no evidence or indication that we spread tumor around further, especially now that we don't get into the peritoneal organs when we do this surgery anymore, with the pleurectomy and decortication. But the issue of localized recurrence in the incision is there. And so those patients, we do recommend that they undergo either radiation or a redo surgery. And particularly, in my experience, the 10% to 20% of patients that I have seen, I have resected that area. And it's usually a localized resection because we catch it early. Not only can the patient see their incision, but we get imaging every four to six months. So we catch it early. And then we'll often treat that. So yes, there is that 10% to 20% risk. And that is true that the cancer predilects, goes to incisions. We try to prevent all that in the operating room. And then if it does go to the incision, yes, the patient will have a potential another operation or radiation. But it's a lot less invasive, a lot less a lot easier to recover, usually an hour or two-hour surgery. And they're home within a day or two. [MUSIC PLAYING]