New research suggests that the two major types of pleural mesothelioma surgery have about the same impact on patients’ quality of life afterward.
Thoracic surgeons at Switzerland’s University Hospital Zurich compared the results of 42 mesothelioma patients. Patients had either extrapleural pneumonectomy (EPP) or lung-sparing PD surgery between 2013 and 2017.
Patients answered questions about their health in the weeks and months after pleural mesothelioma surgery. Their answers show that, where post-surgical quality of life is concerned, it may not matter which procedure a person has.
Two Approaches to Pleural Mesothelioma Surgery
Pleural mesothelioma tumors start on the membranous tissue (pleura) that surrounds the lungs. A healthy pleura is thin and flexible and expands to accommodate the lungs during respiration. In a person with mesothelioma, this membrane becomes thick and stiff, constricting the lungs and causing shortness of breath.
For patients who are healthy enough, surgery provides the best hope for a cure. Both types of pleural mesothelioma surgery involve removing the diseased pleura, all or part of the diaphragm, and other at-risk tissues in the chest.
During EPP, surgeons also remove the lung on the side of the chest where the tumor is. PD (pleurectomy with decortication) leaves the lungs in place.
Multiple studies show the likelihood of serious complications and even death is higher with EPP. But it is also more likely to result in complete mesothelioma resection, which improves the chances of survival. Surgeons are divided over which pleural mesothelioma surgery approach is best.
Assessing Quality of Life After Surgical Treatment
The possibility of impaired quality of life is sometimes used as an argument against the most extensive type of pleural mesothelioma surgery. But the new Swiss study suggests that argument may no longer be valid.
The prospective study followed the cases of 42 mesothelioma patients over a four-year period. Patients all started with chemotherapy. Seven went on to have EPP surgery. The remaining 35 underwent PD.
Patients’ baseline quality of life was established by pre-surgical questionnaires. Patients filled out questionnaires again at six weeks and at four months after their operations.
The results suggest that either surgery could be right for select patients. Several lung function parameters declined after surgery, regardless of which operation a patient had. But patients returned to their preoperative quality of life by about four months after either type of pleural mesothelioma surgery.
“According to these results, QoL is no longer severely impaired after EPP compared with PD, and therefore should not be used as an argument against EPP in principle,” writes lead investigator Olivia Lauk. “However, [each] indication has to be carefully evaluated for each patient.”
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Lauk, O, et al, “Quality of Life Is Not Deteriorated After Extrapleural Pneumonectomy vs. (Extended) Pleurectomy/Decortication in Patients With Malignant Pleural Mesothelioma”, December 8, 2021, Frontiers in Surgery, https://www.frontiersin.org/articles/10.3389/fsurg.2021.766033/full