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Clinical Impact of Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The clinical impact of extrapleural pneumonectomy in malignant pleural mesothelioma is poorly investigated.

Methods

Between 1997 and 2007, 29 consecutive patients underwent extrapleural pneumonectomy for mesothelioma and adjuvant chemoradiotherapy. Function (spirometry, arterial blood gas analysis, 6-min walk test, and echocardiographic fraction ejection estimation), symptoms (quantification of pain, dyspnea, cough, fever, weight loss, and Karnofsky performance status) and quality of life [Medical Outcomes Study Short Form, 36 item (SF-36) and St. George’s Respiratory Questionnaire] were timely evaluated. Data were prospectively collected and retrospectively reviewed.

Results

Only one postoperative death occurred. 30-day postoperative morbidity was 41%. Median survival was 19.5 months with 17 patients still alive at 1 year and 10 at 2 years, respectively. At 3 months, the expected decrement of forced expiratory volume in 1 s (P = 0.06) and forced vital capacity (P = 0.09) was not significant. Conversely, arterial blood gas, 6-min walk test, cardiac fraction ejection, pain (P < 0.05), dyspnea (P < 0.01), cough (P < 0.05), fever (P < 0.01), weight loss (P < 0.01), performance status (P < 0.01), SF-36 physical (P < 0.01), SF-36 mental (P < 0.05), St. George’s Respiratory Questionnaire symptom (P < 0.01), activity (P < 0.05), and impact on mood (P < 0.05) improved. At 12 months, the amelioration of pain, dyspnea, performance status, and physical-related quality of life parameters remained stable. Thereafter, all parameters progressively deteriorated, although pain and dyspnea still persisted above the baseline values even after 24 months in all survivors. Postoperative improvement of pain (P = 0.04), dyspnea (P = 0.04), 6-min walk test (P = 0.03), and SF-36 physical (P = 0.04) and mental (P = 0.03) components were positive prognosticators.

Conclusions

Extrapleural pneumonectomy has a significant and durable impact on function and symptoms as well as on physical and mental components of quality of life in patients with malignant pleural mesothelioma.

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Acknowledgment

We thank Andrea Duggento, PhD, for his help with the statistical analysis. Supported in part by grant 60% 2010 from the Tor Vergata University.

Disclosure

No author has actual or potential conflict of interest in accordance with the journal policies.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Tor Vergata University, Rome, Italy

    Vincenzo Ambrogi MD & Tommaso Claudio Mineo MD

  2. Department of Biochemistry, Section of Pathology, Second University of Naples, Naples, Italy

    Alfonso Baldi MD

  3. Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Rome, Italy

    Orazio Schillaci MD

Authors
  1. Vincenzo Ambrogi MD
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  2. Alfonso Baldi MD
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  3. Orazio Schillaci MD
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  4. Tommaso Claudio Mineo MD
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Corresponding author

Correspondence to Vincenzo Ambrogi MD.

Additional information

This study was conducted for the Mesothelioma Study Group.

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Ambrogi, V., Baldi, A., Schillaci, O. et al. Clinical Impact of Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma. Ann Surg Oncol 19, 1692–1699 (2012). https://doi.org/10.1245/s10434-011-2171-8

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  • DOI: https://doi.org/10.1245/s10434-011-2171-8

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