Complications After PD Surgery for Mesothelioma

Durable air leak is one of the most common complications after PD surgery for pleural mesothelioma, according to the authors of a new study. People with overall better health are less likely than others to experience the problem. 

Air leaks happen when inhaled air does not stay in the alveoli in the lungs. Instead, it leaks into the area around the lungs. This can cause breathing problems and put pressure on the heart. Too much leaked air can even collapse a lung.

A new Japanese study found that more than half of mesothelioma patients analyzed experienced serious complications after PD surgery. One in three patients suffered from air leak for more than ten days. 

Pleurectomy/Decortication for Mesothelioma

Pleural mesothelioma is a membrane cancer caused by asbestos. Tumors arise on the pleural membrane that surrounds the lungs. Pleurectomy/decortication (PD) surgery is one of two major surgical approaches to pleural mesothelioma. The other is extrapleural pneumonectomy (EPP). 

Both types of surgeries remove mesothelioma tumors from the pleural membrane. They also remove other at-risk tissues, including part of the diaphragm. But many surgeons consider PD to be safer. Fewer patients suffer life-threatening complications after PD surgery. 

The difference has to do with the lungs. During EPP surgery, doctors remove the lung that is closest to the mesothelioma tumor. But pleurectomy/decortication leaves both lungs in place. This is why it is also called “lung-sparing” surgery. 

Air Leak Complications After PD Surgery

An air leak can happen when the lungs are damaged. The damage can come from disease or from an intervention like surgery. About half of patients who have all or part of their lung removed develop an air leak. They usually resolve by themselves in a few hours or days.

But the new study found that almost a third of the mesothelioma patients analyzed had an air leak that lasted more than 10 days after pleurectomy/decortication.  It was one of the most common serious complications after PD surgery for mesothelioma. Three percent of air leak patients had another operation to control the problem.

Researchers at Japan’s Hyogo College of Medicine wanted to know if these longer or “durable” air leaks were predictable. They discovered three risk factors for durable air leaks in patients having chemotherapy followed by PD. 

They were:

• Overall health (performance status)
• Prognostic nutritional index (serum albumin level and total lymphocyte count)
• Pleural effusion (overproduction of lung fluid)

When they considered these variables all together, they found that only one remained as a risk factor for air leak complications after PD surgery. 

“On multivariate analysis, performance status remained the only variable predicted for AL10 [air leak of more than 10 days],” writes study author Akifumi Nakamura. 

In other words, the healthier a patient was before treatment, the less likely they were to experience air leak complications after PD surgery. 

More than half of the patients in the study experienced a Grade III or worse complication. But only 2.5% of patients died within three months of the surgery. 

Source:

Nakamura, A, et al, “Complications and Predictive Factors for Air Leak > 10 Days with Neoadjuvant Chemotherapy Followed by Pleurectomy/Decortication for Malignant Pleural Mesothelioma”, October 29, 2020, Annals of Surgical Oncology, Epub ahead of print, https://link.springer.com/article/10.1245/s10434-020-09275-y