Commentary: Focused attention on proactive identification of deep venous thrombosis after pleurectomy/decortication for malignant pleural mesothelioma

Our plain-English summary of Commentary: Focused attention on proactive identification of deep venous thrombosis after pleurectomy/decortication for malignant pleural mesothelioma, by S.S. Groth, R.T. Ripley, P.W. Carrott, et al (The Journal of Thoracic and Cardiovascular Surgery, 2020).

The study

• Authors: S.S. Groth, R.T. Ripley, P.W. Carrott, B.M. Burt
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2020;160(4):1075-1076
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This is a short commentary, not an original study. Its four authors discussed a separate study by De Leon and colleagues. That study prospectively evaluated routine screening for deep venous thrombosis (DVT, blood clots in the leg veins) after pleurectomy/decortication, a surgery for malignant pleural mesothelioma. As the commentary described it, patients had leg vein tests before surgery and every 7 days afterward, or sooner if they showed signs of a clot in the legs or lungs. After 7 patients with clots found before surgery were excluded, 93 patients operated on over 27 months were analyzed. Despite preventive heparin, that study found a 29% incidence of DVT and an 11% incidence of pulmonary embolus (a clot in the lungs). 33% of the DVTs had no symptoms. The commentary's authors noted that, without a control group, it was unclear whether early detection lowered the risk of pulmonary embolus. They wrote that the higher DVT rate than in an earlier study of a different operation was likely due to surveillance bias. They noted a median screening cost of $2103 per patient. They concluded that, without a way to sort patients by risk, a surveillance program was justified.

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: Commentary (editorial) on a separate prospective study by De Leon and colleagues; it reports no new data of its own
• Who was studied: In the De Leon study as described by the commentary: 93 patients who underwent pleurectomy/decortication for malignant pleural mesothelioma over a 27-month period, after 7 patients with a DVT on preoperative testing were excluded
• Exposure: No asbestos exposure is discussed. The factor studied in the De Leon study was pleurectomy/decortication surgery followed by routine screening with lower-extremity noninvasive studies at baseline and every 7 days after surgery, or earlier if there were signs of DVT or pulmonary embolus.
• Main results:
  • In the De Leon study, despite heparin prophylaxis, 29% of patients developed postoperative DVT (median time to event 7 days, range 1-14 days)
  • In the De Leon study, 11% of patients had a pulmonary embolus (median time to event 7 days, range 1-23 days)
  • 33% of the DVTs in the De Leon cohort were asymptomatic
  • The median cost of surveillance per patient was $2103. The commentary compared this with an average intensive care cost after a pulmonary embolus of $9898 per day.
  • In this cohort, in which all patients were high risk, Caprini risk scores could not distinguish which patients developed DVT
• The authors' conclusion: The commentary's authors concluded that, in the absence of a method to risk-stratify patients, a DVT surveillance program is justified
• Limitations the authors state:
  • The commentary's authors noted that the De Leon study had no control group, so it is unclear whether early detection of asymptomatic DVTs reduced the risk of pulmonary embolus
  • The commentary's authors said the higher DVT incidence (29%) compared with the same group's earlier extrapleural pneumonectomy study (6.4%) was likely due to surveillance bias
  • The commentary's authors noted that any benefit of early detection must be weighed against hematologic complications from anticoagulation

Topics

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

Medical terms in this study, explained in our Lexicon: Pleurectomy/Decortication (P/D), Pleural Mesothelioma.

Related studies

• Routine surveillance for diagnosis of venous thromboembolism after pleurectomy for malignant pleural mesothelioma — L.E. De León, C.E. Bravo-Iñiguez, et al. (2020)
• Malignant peritoneal mesothelioma associated with deep vein thrombosis following radiotherapy for seminoma of the testis — F. Sato, H. Yamazaki, et al. (2000)
• Commentary: To scan or not to scan: No longer the question for mesothelioma patients after pleurectomy — E.A. David, S.M. Atay (2020)
• Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma — S. Hasegawa (2014)
• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)
• Quality of life after radical pleurectomy decortication for malignant pleural mesothelioma — N.M. Mollberg, Y. Vigneswaran, et al. (2012)

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