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Influence of Pleurectomy and Decortication in Health-Related Quality of Life Among Patients with Malignant Pleural Mesothelioma

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Abstract

Background

Complete macroscopic resection surgery, pleurectomy and decortication (PD) improve survival in selected patients with malignant pleural mesothelioma (MPM). Yet its value has been questioned because of concern that this extensive surgical procedure may disrupt health-related quality of life (HRQoL).

Methods

HRQoL was studied in patients undergoing PD surgery for MPM using EORTC QLQ-C30 instrument at baseline (prior to surgery), 1, 4–5, 7–8, and 10–11 months following surgery. Global health and variables in function and symptom domains were investigated. Sub-groups analyses were performed for ECOG performance status (PS), histological sub-types and pathological tumor volume (pTV). Within-patient comparisons to baseline scores were made using Wilcoxon signed-rank test. Trends over time were evaluated using Cuzick’s nonparametric test.

Results

There were 114 patients with median age of 70 years (range: 50–88) and PS 0: 35 (30.7%), epithelioid histology: 61 (53.5%) and volume <600 ml: 58 (50.9%). Patients with good PS (PS 0), epithelioid histology and small pTV had greater level of functioning and were less symptomatic at baseline. Overall global health worsened at the first postoperative month (p = 0.0005) with subsequent improvement. Non-epithelioid histology and patients with large pTV demonstrated greater improvement in global health, function and symptoms domains following a PD.

Conclusions

At baseline, the overall health-related quality of life, function and symptom domains were adversely affected in non-epithelioid histology and patients with large pTV. However, greatest improvement in global health, symptom and function domains were observed first month after PD and during the follow-up in these sub-groups.

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Author information

Author notes

  1. Wickii T. Vigneswaran

    Present address: Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, 2160 S First Avenue, (Bdg110, Suite 6256), Maywood, IL, 60153, USA

Authors and Affiliations

  1. Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL, 60637, USA

    Wickii T. Vigneswaran, Diana Y. Kircheva & Amy Durkin Celauro

  2. Department of Biostatistics, University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL, 60637, USA

    Sydeaka Watson

  3. Section of Hematology and Oncology, Department of Medicine, University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL, 60637, USA

    Berkley Rose & Hedy L. Kindler

  4. Department of Pathology, University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL, 60637, USA

    Aliya N. Husain

  5. Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, 2160 S First Avenue, (Bdg110, Suite 6256), Maywood, IL, 60153, USA

    Diana Y. Kircheva & Adrian E. Rodrigues

Authors
  1. Wickii T. Vigneswaran
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  2. Diana Y. Kircheva
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Correspondence to Wickii T. Vigneswaran.

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Vigneswaran, W.T., Kircheva, D.Y., Rodrigues, A.E. et al. Influence of Pleurectomy and Decortication in Health-Related Quality of Life Among Patients with Malignant Pleural Mesothelioma. World J Surg 42, 1036–1045 (2018). https://doi.org/10.1007/s00268-017-4264-4

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  • DOI: https://doi.org/10.1007/s00268-017-4264-4

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