|

Empyema After Mesothelioma Surgery: Avoiding a Serious Complication

ByAlex Strauss

empyema after mesothelioma surgeryA new study of a rare condition called empyema after mesothelioma surgery shows it can dramatically lengthen hospital stay and shorten survival. 

Empyema refers to pockets of pus in the pleural space around the lungs. It is the result of a lingering bacterial infection. Empyema is a serious complication in people who have surgery for pleural mesothelioma. 

The new study comes from the International Mesothelioma Program at Boston’s Brigham & Women’s Hospital. It finds that patients with empyema after mesothelioma surgery live half as long as those without it. They also spend a lot more time in the hospital. 

The researchers say air leaking from the lungs can raise the risk for this complication. In their new report, they offer some solutions for avoiding both the problem and its cause. 

Where Does Empyema After Mesothelioma Surgery Come From?

Pleural mesothelioma occurs on the pleura, a multi-layer sheet of tissue that surrounds the lungs. As tumors spread out across this membrane, it gets harder for the lungs to expand. Fluid buildup can make this symptom even worse. 

Pleurectomy with decortication (PDC) is mesothelioma surgery to remove the diseased pleura. Surgeons also scrape any cancer they can see off the surface of the lungs. They remove as much cancer as possible to prevent recurrence. Many patients also get a rinse of heated chemotherapy drugs in their chest (HITHOC).. 

Empyema after mesothelioma surgery occurs when an infection does not clear up quickly. Pus collects in the space between the lungs and the chest wall. The fluid puts pressure on the lungs. People with empyema may still struggle to breathe, even after surgeons remove their mesothelioma tumor. 

A Serious Complication for Mesothelioma Patients

The goal of the new study was to identify risk factors for empyema after mesothelioma surgery. It was also to determine how common it is, why some people get it, and how it might be avoided. 

Researchers analyzed the cases of 355 patients who had pleurectomy with decortication for mesothelioma. The cases span a nine-year period. There were 263 men in the study and their median age was 69. Eighty-seven patients had some treatment prior to surgery. Three out of four patients had HITHOC after surgery. 

Twenty-four patients (6.8%) developed empyema after mesothelioma surgery. These patients had a median survival of 11.7 months. Mesothelioma patients without empyema had a median survival of 21.3 months. 

The patients most likely to develop this complication were men, those who needed prosthetic mesh to patch some open area, and those with prolonged air leak. This is when air leaks out of the lungs from an unhealed hole. 

Moshe Lapidot, lead author of the new study, says addressing the air leak problem might cut down on the incidence of empyema after mesothelioma surgery.

He writes, “Postoperative empyema following PDC is associated with prolonged length of stay and higher mortality. The rates of this serious postoperative complication might decrease by developing better strategies to avoid prolonged air leak after PDC.”

Mesothelioma surgery patients tend to have the best outcomes at higher-volume medical centers with experienced mesothelioma doctors. CLICK HERE to locate a mesothelioma expert near you.

Source:

Lapidot, M, et al, “Postoperative empyema after pleurectomy decortication for malignant pleural mesothelioma”, October 4, 2021, Annals of Thoracic Surgery, Online ahead of print, https://www.annalsthoracicsurgery.org/article/S0003-4975(21)01681-7/pdf

Similar Posts

  • | |

    Doctors Describe "Concrete Therapeutic Approach" for Mesothelioma

    ByAlex Strauss

    A team of medical researchers in Italy have achieved what they are calling “excellent” tumor control and survival results in malignant pleural mesothelioma patients using a combination of surgery, chemotherapy, and radiotherapy. Caused by exposure to asbestos, mesothelioma typically spreads quickly across the lung-encasing membrane called the pleura. There is no known cure but treatments are improving. In the current prospective study, 20 malignant pleural mesothelioma patients underwent radical pleurectomy/decortication followed by high doses of radiation. After surgeons removed as much of the visible mesothelioma tumor and surrounding tissue as possible, patients received 50Gy of radiation to the effected side of their chest, delivered in 25 fractions. Regions of particular concern for mesothelioma regrowth got an extra radiation “boost” to…

  • | |

    Does Radiotherapy Reduce Mesothelioma Pain?

    ByAlex Strauss

    A new study says there is not enough evidence to support the use of radiotherapy for the treatment of pain associated with malignant pleural mesothelioma. Researchers at the University of Edinburgh in Scotland reviewed a range of past studies on mesothelioma pain and radiotherapy by searching databases that date back as far as 1974. To be eligible to be included in their review, the study had to focus on malignant pleural mesothelioma and radiotherapy given “with the intent of improving pain”. The study also had to report doses and fractionation of the radiotherapy and how the pain responded. In all, the researchers found eight studies on mesothelioma pain and radiotherapy that met the criteria. Two of the studies were prospective…

  • | |

    Radiotherapy for Mesothelioma: Better But Still Limited

    ByAlex Strauss

    A form of highly-targeted radiation therapy for mesothelioma is better than it used to be, but is still risky. That is the message of a recent article on intensity-modulated radiation therapy (IMRT) in Seminars in Thoracic and Cardiovascular Surgery. Author Kenneth E. Rosenzweig, MD, a Radiation Oncologist with Mount Sinai Hospital in New York, reviewed recent studies on IMRT and mesothelioma. He concludes that, while the “troubling toxicity” associated with IMRT when it was first introduced has not been entirely eliminated, the fact that clinicians now have more experience with it is making a positive difference for mesothelioma patients. Before targeted therapies like IMRT were available, high-dose radiation was not usually a feasible option for mesothelioma since the irregular shape…

  • | |

    A Second-Line Option for Mesothelioma?

    ByAlex Strauss

    Although survival was not significantly extended, the chemotherapy drug vinorelbine might be a treatment option for mesothelioma patients whose cancer has returned after first-line chemotherapy with pemetrexed. A new study on vinorelbine as a second-line treatment finds that the drug is “moderately active” in mesothelioma patients who were initially treated with pemetrexed-based chemotherapy. Pemetrexed (Alimta), along with a platinum-based drug like cisplatin, is the primary first-line drug therapy for mesothelioma. But vinorelbine is gaining attention as a possible option for mesothelioma, in part because it is available in a less expensive generic form. In “Vinorelbine in pemetrexed-pretreated patients with malignant pleural mesothelioma”, the Italian authors detail the results of their study on 59 patients with unresectable pleural mesothelioma.  These patients…

  • | |

    Repeat HIPEC Improves Mesothelioma Survival

    ByAlex Strauss

    If one cytoreductive surgery and HIPEC procedure for mesothelioma is good, subsequent treatments may be even better. That is the central message of research conducted at the Moffitt Cancer Center in Florida. The study’s aim was to assess overall survival among peritoneal mesothelioma patients who had not just one, but two or more rounds of heated intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery. The cytoreduction/HIPEC approach has become popular for peritoneal mesothelioma, a treatment-resistant cancer of abdominal membranes caused by asbestos. Cytoreductive surgery involves removing as much of the mesothelioma tumor as possible from the abdomen. Because the shape and spreading pattern of mesothelioma tumors make complete cytoreduction difficult, the surgery is often followed by a rinse with a heated solution…

  • | |

    Value of Mesothelioma Surgery Challenged for Healthy Patients

    ByAlex Strauss

    New research conducted in Italy and presented at the 15th World Conference on Lung Cancer in Sydney, Australia suggests that mesothelioma surgery – no matter what kind – may not offer a survival advantage over medical management for the healthiest of patients. Mesothelioma is a rare but aggressive malignancy that is highly resistant to standard cancer treatments. The two types of mesothelioma surgery considered to be options for people with resectable cancer are pleurectomy decortication (P/D) or extrapleural pneumonectomy (EPP). While EPP is more radical than P/D because it involves removing a lung, both carry a heavy risk of complications and, according to the Italian researchers, may not be of value for certain patients. The study reviewed data from 1,365…