Surgery for Solitary Fibrous Tumors of the Pleura: A Review of the Available Evidence

SIMPLE SUMMARY: This is a review of the evidence on the use of surgery for solitary fibrous tumors of the pleura. Solitary fibrous tumors of the pleura are rare tumors that can arise in the chest from both visceral and parietal pleura. Surgery is the cornerstone of their treatment; as minimally invasive techniques, both thoracoscopy or robotics can be used according to the dimension, position, and infiltration of neighboring organs. A radical resection with free margins is the main target of surgery. Even if the long-term results are generally good, the risk of local or distant recurrence is always possible, in particular in cases of more aggressive histological types. In cases of local recurrence, surgery can be proposed if feasible. ABSTRACT: Solitary fibrous tumors of the pleura (pSFT) are a relatively rare neoplasms that can arise from either visceral or parietal pleura and may have different aggressive biological behaviors. Surgery is well known to be the cornerstone of the treatment for pSFT. We reviewed the existing literature, focusing on the role of surgery in the management and treatment of pSFT. All English-written literature has been reviewed, focusing on those reporting on the perioperative management and postoperative outcomes. Surgery for pSFT is feasible and safe in all experiences reported in the literature, but surgical approaches and techniques may vary according to the tumor dimensions, localization, and surgeons’ skills. Long-term outcomes are good, with a 10-year overall survival rate of more than 70% in most of the reported experiences; on the other hand, recurrence may happen in up to 17% of cases, which occurs mainly in the first two years after surgery, but case reports suggest the need for a longer follow-up to assess the risk of late recurrence. Malignant histology and dimensions are the most recognized risk factors for recurrence. Recurrence might be operated on in select patients. Surgery is the treatment of choice in pSFT, but a radical resection and a careful postoperative follow-up should be carried out.