Changes in lung function after surgery for mesothelioma

Our plain-English summary of Changes in lung function after surgery for mesothelioma, by T. Ploenes, T. Osei-Agyemang, A. Krohn, et al (Asian Cardiovascular & Thoracic Annals, 2013).

The study

• Authors: T. Ploenes, T. Osei-Agyemang, A. Krohn, C.F. Waller, V. Duncker-Rohr, M. Elze, B. Passlick
• Journal: Asian Cardiovascular & Thoracic Annals
• Published: 2013;21(1):48-55
• Cited by: 26 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The effect of pleurectomy/decortication or extrapleural pleuropneumonectomy on pulmonary function has not yet been evaluated. The aim of this study was to determine the parameters of pulmonary function before and after pleurectomy/decortication or extrapleural pleuropneumonectomy.

Methods: We conducted a review of 48 patients with unilateral malignant pleural mesothelioma who underwent pleurectomy/decortication or extrapleural pleuropneumonectomy. Data including medical history, histology, survival, and pre- and postoperative pulmonary function were extracted from the medical database of the University Medical Center Freiburg, or sought by telephone interview with the general practitioner or patients.

Results: 25 patients underwent extrapleural pleuropneumonectomy and 23 had pleurectomy/decortication. Pulmonary function was not significantly reduced in the pleurectomy/decortication group postoperatively. In the extrapleural pleuropneumonectomy group, the median preoperative total lung capacity of 4.8 L (77.7%) differed significantly from the postoperative total lung capacity of 3.5 L (55.3%; p <0.0006). The median vital capacity was significantly reduced from 2.8 L (77.7%) preoperatively to 1.8 L (47.6%) postoperatively (p <0.0002). Other parameters were also highly significantly reduced after extrapleural pleuropneumonectomy.

Conclusions: Pleurectomy/decortication preserved good pulmonary function, whereas extrapleural pleuropneumonectomy significantly reduced pulmonary function, which may lead to dyspnea and influence the quality of life of these patients.

In plain English

This retrospective review covered 48 patients with one-sided malignant pleural mesothelioma who had surgery at the University Medical Center Freiburg, Germany. Twenty-five had extrapleural pneumonectomy, which removes the lung, and 23 had pleurectomy/decortication, which removes the pleura but not the lung. Asbestos exposure was confirmed by lung tissue examination in 25 patients (52%). Lung function was measured before surgery in all patients and afterwards in 28. After pleurectomy/decortication, only vital capacity changed significantly, falling slightly from 2.5 L (87%) to 2.3 L (69.7%). After extrapleural pneumonectomy, all four measures fell significantly. Total lung capacity fell from 4.8 L (77.7%) to 3.5 L (55.3%), and vital capacity fell from 2.8 L (77.7%) to 1.8 L (47.6%). Survival did not differ significantly between the groups. Pneumonectomy patients stayed longer in hospital (median 22 versus 13 days). The authors concluded that pleurectomy/decortication preserved good lung function while extrapleural pneumonectomy significantly reduced it, which may cause breathlessness and affect quality of life. They noted that lung function was tested at widely varying times after surgery.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of patients treated surgically at one hospital, comparing lung function before and after two types of operation
• Who was studied: 48 patients with unilateral malignant pleural mesothelioma operated on at the University Medical Center Freiburg, Germany: 25 had extrapleural pneumonectomy (EPP) and 23 had pleurectomy/decortication (P/D). There were 11 women and 37 men, with a median age of 64. Postoperative lung function was measured in 28 patients (15 EPP, 13 P/D). Study years were not stated; surviving patients were contacted in September 2011.
• Exposure: The comparison was between two operations: EPP (removal of lung, pleura, pericardium and diaphragm) and P/D (removal of the pleura without the lung). Asbestos exposure was counted as positive only if more than 100 asbestos bodies were found per gram of wet lung tissue (Helsinki Criteria). On that basis it was confirmed in 25 of 48 patients (52%). Fiber types were not reported.
• Main results:
  • In the P/D group, preoperative and postoperative lung function did not differ significantly, apart from vital capacity.
  • In the P/D group, median vital capacity fell slightly but significantly, from 2.5 L (87%) before surgery to 2.3 L (69.7%) after (p less than 0.04).
  • In the EPP group, median FEV1 fell from 2.3 L (78%) before surgery to 1.5 L (49.3%) after (p less than 0.0005).
  • In the EPP group, median forced vital capacity fell from 2.7 L (76.8%) to 1.8 L (48%) (p less than 0.01).
  • In the EPP group, median total lung capacity fell from 4.8 L (77.7%) before surgery to 3.5 L (55.3%) after (p less than 0.0006).
  • In the EPP group, median vital capacity fell from 2.8 L (77.7%) before surgery to 1.8 L (47.6%) after (p less than 0.0002).
  • Survival did not differ significantly between the P/D group (median 881 days) and the EPP group (median 669 days).
  • In multivariate analysis (type of operation, histology, TNM stage, postoperative fall in FEV1), histological subtype was the only factor that significantly influenced median survival (p less than 0.03).
  • Median hospital stay was 22 days (range 11 to 55) in the EPP group and 13 days (range 8 to 68) in the P/D group (p less than 0.0002). Eleven EPP patients went on to rehabilitation for a median of 28 days; no P/D patients did.
  • In the EPP group, 12 patients (48%) had major postoperative complications and one died after surgery from bleeding during tracheostomy. In the P/D group, 2 patients (8%) had minor postoperative complications.
• The authors' conclusion: The authors concluded that pleurectomy/decortication preserved good lung function. Extrapleural pneumonectomy significantly reduced lung function, which they said may lead to shortness of breath and affect patients' quality of life.
• Limitations the authors state:
  • The authors could not exclude that the fall in lung function after EPP was partly due to the wide range of times after surgery at which lung function was measured.
  • The authors noted that the low number of events per variable may affect the accuracy and statistical significance of the multivariate survival analysis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleurectomy/Decortication (P/D), Pleural Mesothelioma, Histology, Total Lung Capacity (TLC), Dyspnea, Quality of Life.

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