Japanese researchers say P/D surgery for mesothelioma improves quality of life for most patients, even if their lung function gets worse.
Doctors at the Hyogo College of Medicine tracked the cases of forty-five patients who had P/D surgery for mesothelioma between 2014 and 2018.
Lung function tests showed most pleural mesothelioma patients could not breathe as well after surgery as they did before. Their energy, vitality, and social functioning also decreased. But patients reported better mental health after surgery and significantly less pain.
The researchers conclude that quality of life after P/D surgery for mesothelioma may have less to do with breathing than previously thought.
What is P/D Surgery for Mesothelioma?
Pleural mesothelioma tumors grow on the pleura, a thin membrane that encases the lungs. They are most common in people with a history of asbestos exposure.
P/D stands for pleurectomy with decortication. P/D surgery for mesothelioma is one of two main surgical approaches to this pleural cancer.
The other approach is extrapleural pneumonectomy (EPP). EPP involves removing a lung along with the diseased pleural membrane and other tissues in the chest. Serious complications and even death are common after EPP.
P/D is also a major operation with significant risks. The difference between EPP and P/D surgery for mesothelioma is that P/D leaves the lungs intact. Surgeons remove the mesothelioma tumor, the pleural lining, all or part of the diaphragm, and other tissues that could host new tumors.
Patients who have P/D surgery for mesothelioma tend to have less pain, fewer complications, and faster recovery. Many top surgeons now prefer this approach over EPP.
Decreases in Physical Function After P/D Surgery
The Hyogo College of Medicine researchers asked 65 P/D surgery patients to complete a health survey and to undergo pulmonary function tests. They asked patients to do the surveys and tests at several points before surgery and at three, six, and 12 months afterward.
Forty-five patients completed the survey. They reported that their physical function decreased from 78 to 65 after P/D surgery for mesothelioma. Their ability to perform their physical roles also decreased from 69 to 41.
General health perceptions, vitality, and social functioning also decreased after P/D surgery for mesothelioma but eventually returned to baseline.
Assessing Surgical Patients’ Quality of Life
The good news is that body pain decreased from 74 to 52. Although it rose to 62 a year after surgery, it remained lower than it was before surgery. Mental health also tended to improve from 58 to 70.
Thirty-eight of the 45 patients also underwent pulmonary function tests after P/D surgery for mesothelioma. Forced vital capacity decreased from 98% to 61%. The amount of air they could exhale in one second decreased from 93% to 67% and did not increase.
The researchers say it is significant that patients’ mental health improved, even though their breathing usually did not. They suggest that pulmonary function tests do not tell the whole story when it comes to quality of life after P/D surgery for mesothelioma.
“Despite the lack of recovery in lung function, QOL in mental aspects tended to improve, suggesting that pulmonary function tests alone are limited in assessing QOL,” writes lead study author Toru Nakamichi.
Pleural mesothelioma is the most common form of asbestos cancer. Rates are slowly declining in the US. But the incidence of mesothelioma is still rising in many other countries.
Nakamichi, T, et al, “Quality of life and lung function after pleurectomy/decortication for malignant pleural mesothelioma”, May 8, 2021, Interactive Cardiovascular and Thoracic Surgery, Online ahead of print, https://academic.oup.com/icvts/advance-article/doi/10.1093/icvts/ivab139/6272483