Extrapleural pneumonectomy (EPP) is a large and complex procedure that involves removing a mesothelioma patient’s lung, lung lining, diaphragm and other tissues in an effort stop the spread of mesothelioma. Although some studies have indicated a mesothelioma survival benefit with EPP, the procedure has come under fire because of its high rate of death and complications.
But the new EPP study suggests that it can be performed safely. The study evaluated the cases of 251 mesothelioma patients from three high-volume hospitals – University Hospital Zurich in Switzerland, Medical University Vienna in Austria, and Toronto General Hospital in Ontario. Patients in the 10-year study received platinum-based induction chemotherapy prior to EPP. The researchers compared the 30-day and 90-day rates of death or complications such as pulmonary embolism, postoperative bleeding, acute respiratory distress, and empyema (accumulation of pus in the pleural space) and looked at risk factors for each.
Overall, the 30-day mortality rate for all mesothelioma patients who had induction chemotherapy first and had their operations in one of these large, experienced centers was just 5%. Eight percent of patients died within 90 days of the operation. Although some studies have put the complication rate from EPP as high as 65%, major complications occurred in only 30% of patients in the current study.
But the researchers did find that certain mesothelioma patients are not good candidates for EPP. “The rates of 30-day and 90-day mortality were significantly higher in patients with high preoperative C-reactive protein values,” cautions study author Olivia Lauk, MD, of the University Hospital Zurich. Patients who did not score well on lung function tests prior to the operation or who had to be in surgery longer also had more complications and lower survival rates.
The researchers conclude that the keys to better outcomes with EPP are thorough evaluation of patients and experienced surgeons. “EPP after induction chemotherapy is a demanding procedure but can be performed with acceptable morbidity and mortality if patients are well selected and treated at dedicated high-volume malignant pleural mesothelioma centers,” writes Dr. Lauk.
Lauk, O et al, “Extrapleural pneumonectomy after induction chemotherapy: perioperative outcome in 251 mesothelioma patients from three high-volume institutions”, August 7, 2014, Annals of Thoracic Surgery, Epub ahead of print