Clinical impact of extrapleural pneumonectomy for malignant pleural mesothelioma

Vincenzo Ambrogi, Alfonso Baldi, Orazio Schillaci, Tommaso Claudio Mineo

Research output: Contribution to journalArticle

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-minwalk 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.

Original languageEnglish
Pages (from-to)1692-1699
Number of pages8
JournalAnnals of Surgical Oncology
Volume19
Issue number5
DOIs
Publication statusPublished - May 2012

ASJC Scopus subject areas

  • Surgery
  • Oncology

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