Empyema After Mesothelioma Surgery: Avoiding a Serious Complication

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.”

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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

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