Reporting in the European Journal of Cardiothoracic Surgery, a group of Italian doctors say preexisting conditions, as well as an infection called pleural sepsis, may be the biggest limiters to mesothelioma survival after extrapleural pneumonectomy.
The Mesothelioma Surgery Debate
There has been significant debate among the world’s top cancer surgeons in recent years over which of the two major types of mesothelioma surgery is best.
The most radical type of mesothelioma surgery, extrapleural pneumonectomy (EPP), involves the removal of the pleural membrane, all or part of the diaphragm, other at-risk tissues, and one lung. Pleurectomy with decortication (PD) also removes the pleura and other tissues, but leaves both lungs intact.
Although there have been cases of long mesothelioma survival after EPP, it also carries a much higher rate of complications and death than PD.
Complications After Mesothelioma Surgery
One of the most common complications of EPP surgery for pleural mesothelioma, according to the new Italian study, is an infection known as pleural sepsis.
The retrospective study of 91 mesothelioma patients who underwent EPP between 2000 and 2015 found a six-fold higher frequency of pleural sepsis than in those who had PD. It also found that the condition could crop up more than a year-and-a-half after mesothelioma surgery.
Another factor influencing mesothelioma survival after surgery was the number and type of comorbidities or underlying health problems besides mesothelioma.
The Italian research team found that, although patients undergoing PD tended to have more serious comorbidities, the number of significant complications after surgery was roughly the same between the two groups.
Predicting Mesothelioma Survival
For patients and families considering the possibility of mesothelioma surgery, this study appears to suggest that the number and type of underlying conditions should play a major role in the decision.
“The Charlson Comorbidity Index (CCI) is an independent predictor of survival in malignant pleural mesothelioma patients undergoing radical surgery,” writes study author Maurizio Infante, Chief of Thoracic Surgery at Borgo Trento University Hospital in Verona. “Owing to its significant frequency and adverse impact, pleural sepsis may contribute to a reduced life expectancy after EPP.”
The study concludes that the surgical treatment of pleural mesothelioma “remains debatable”.
Infante, M, Comorbidity, postoperative morbidity and survival in patients undergoing radical surgery for malignant pleural mesothelioma, June 21, 2016, European Journal of Cardiothoracic Surgery, Epub ahead of print