ECLS for Life-Threatening Complications in Mesothelioma Surgery: Is It Worthwhile?

Our plain-English summary of ECLS for Life-Threatening Complications in Mesothelioma Surgery: Is It Worthwhile?, by A. Bellini, A. Dell'Amore, P. Ferrigno, et al (The Thoracic and Cardiovascular Surgeon, 2021).

The study

• Authors: A. Bellini, A. Dell'Amore, P. Ferrigno, N. Sella, P. Navalesi, F. Rea
• Journal: The Thoracic and Cardiovascular Surgeon
• Published: 2021;69(6):548-550
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Extracorporeal life support (ECLS) is an effective method for bridging patients to recovery in cases of respiratory and/or cardiac failure that are potentially reversible and unresponsive to conventional management. Nevertheless, there have been only few reports about the use of ECLS in oncological patients with complications due to their neoplasm or its treatment. We report the use of veno-arterial extracorporeal membrane oxygenation in three cases of severe perioperative complications following surgery for mesothelioma after induction chemotherapy at our Institution.

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In plain English

This short report described three patients at Padova University Hospital in Italy who developed life-threatening heart or lung complications after surgery for epithelioid malignant pleural mesothelioma. All three had received platinum-based chemotherapy before surgery. One had a pleurectomy/decortication and two had an extrapleural pneumonectomy. Each was placed on veno-arterial extracorporeal membrane oxygenation (V-A ECMO), a machine that supports heart and lung function. Two patients, men aged 67 and 57, were put on ECMO mainly as heart support. In both, ECMO was removed with no ECMO-related complication, both left hospital and both completed radiotherapy. They died 18.9 and 10.2 months after diagnosis. The third patient, a 61-year-old woman, was put on ECMO mainly for respiratory failure (ARDS) in her remaining lung. She died 11 days after ECMO was started, from multiorgan failure. The report did not discuss asbestos exposure. The authors concluded that when the condition is potentially reversible, especially heart failure, V-A ECMO may be a temporary bridge in very selected mesothelioma patients.

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: case series of three patients (short communication)
• Who was studied: three adults (a 67-year-old man, a 61-year-old woman and a 57-year-old man) with epithelioid malignant pleural mesothelioma who had surgery after platinum-based induction chemotherapy at Padova University Hospital, Italy, and then developed life-threatening cardiorespiratory complications; dates of treatment not given
• Exposure: No asbestos exposure is reported. The treatment studied was peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) used after right-sided extended pleurectomy/decortication (one patient) or extrapleural pneumonectomy (two patients)
• Main results:
  • V-A ECMO was used successfully as cardiac support in two of the three patients (printed as 66%)
  • Patient 1 (67-year-old man) was taken off ECMO on postoperative day 9 and extubated on day 11, with no ECMO-related complication
  • Patients 1 and 3 left hospital 27 days and 2 months after ECMO removal, respectively, and both completed the trimodality protocol with adjuvant radiotherapy
  • Patient 1 relapsed 10.9 months after surgery and died 3.1 months later (18.9 months from diagnosis)
  • Patient 3 (57-year-old man) survived 4.9 months after surgery until a fatal out-of-hospital cardiac arrest (10.2 months from diagnosis)
  • Patient 2 (61-year-old woman), the one case (printed as 33%) where ECMO was used mainly for respiratory support in pneumonia-associated ARDS of the remaining lung, died 11 days after ECMO implantation from multiorgan failure
• The authors' conclusion: The authors concluded that, when the condition is potentially reversible, especially cardiac failure, V-A ECMO may be a stopgap device until conventional therapies act in very selected malignant pleural mesothelioma patients, allowing hospital discharge and completion of multimodality treatment

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, Neoplasm, Chemotherapy.

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