Effects of extended pleurectomy and decortication on quality of life and pulmonary function in patients with malignant pleural mesothelioma

Our plain-English summary of Effects of extended pleurectomy and decortication on quality of life and pulmonary function in patients with malignant pleural mesothelioma, by D. Burkholder, D. Hadi, R. Kunnavakkam, et al (The Annals of Thoracic Surgery, 2015).

The study

• Authors: D. Burkholder, D. Hadi, R. Kunnavakkam, H. Kindler, K. Todd, A.D. Celauro, W.T. Vigneswaran
• Journal: The Annals of Thoracic Surgery
• Published: 2015;99(5):1775-80
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Maximal cytoreductive surgeries--extrapleural pneumonectomy and extended pleurectomy and decortication (EPD)--are effective surgical treatments in selected patients with malignant pleural mesothelioma. Extended pleurectomy and decortication results in equivalent survival yet better health-related quality of life (HRQoL).

Methods: Patients with malignant pleural mesothelioma were studied for the effects of EPD on HRQoL and pulmonary function. The European Organization for Research and Treatment of Cancer Core Quality of Life Questionaire-C30 was used to evaluate HRQoL before operation, and at 4 to 5 and 7 to 8 months postoperatively. Pulmonary function tests were measured immediately before and 5 to 7 months after the operation. Patients were compared according to World Health Organization baseline performance status (PS).

Results: Of the 36 patients enrolled, 17 were PS 0 and 19 were PS 1 or PS 2 at baseline. Patients in groups PS 1 and PS 2 had significantly worse global health, functional, and symptoms scores. After EPD, PS 0 patients had no change in global health or function and symptoms scores except for emotional function, whereas PS 1 or PS 2 patients showed improvements at 4 to 5 months with further improvements at 7 to 8 months. The PS 0 patients demonstrated a significant decrease in forced vital capacity (p = 0.001), forced expiratory volume in 1 second (p = 0.002), total lung capacity (p = 0.0006) and diffusing capacity of the lung for carbon monoxide (p = 0.003) after EPD, whereas no change was observed in PS 1 and PS 2 patients.

Conclusions: Extended pleurectomy and decortication did not improve overall HRQoL and had a negative impact in pulmonary function in minimally symptomatic patients. In symptomatic patients, a significant improvement in HRQoL was observed after EPD, which continued at late follow-up, although the pulmonary function was not affected. As changes in HRQoL are multidimensional, the preservation of the pulmonary function may have contributed to the net benefit observed in PS 1 and PS 2 patients.

Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This University of Chicago study followed 36 patients with malignant pleural mesothelioma (27 men, 9 women) who had extended pleurectomy and decortication (EPD), surgery removing the pleura, tumor and part or all of the diaphragm. Asbestos exposure was not reported. Patients completed a quality-of-life questionnaire before surgery and at 4 to 5 and 7 to 8 months after, and had lung function tests before and 5 to 7 months after. Seventeen had no symptoms at baseline (performance status 0) and 19 had symptoms (performance status 1 or 2). Symptomatic patients showed modest but significant quality-of-life improvements at 4 to 5 months, continuing at 7 to 8 months, with no significant lung function change. In the symptom-free group, lung function fell significantly (FEV1 from 84.11 to 72.4 percent of predicted). The article is inconsistent on whether their quality of life declined or was unchanged. No correlation was seen between lung function and quality-of-life changes. The authors concluded that preserved lung function may partly explain the symptomatic group's improvement. They noted a small sample limited to patients well enough to complete follow-up.

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: Single-center before-and-after study of patients enrolled in a quality-of-life study, all operated on by one surgeon, compared by baseline WHO performance status
• Who was studied: 36 patients with malignant pleural mesothelioma (27 men, 9 women; median age 70, range 56 to 89) who had EPD at the University of Chicago Hospital; 17 were WHO PS 0, 17 were PS 1 and 2 were PS 2. Study dates not given.
• Exposure: Extended pleurectomy and decortication: removal of the parietal and visceral pleura and tumor, with partial or complete resection of the hemidiaphragm and Gore-Tex reconstruction. Asbestos exposure is not reported.
• Main results:
  • Of the 36 patients, 17 were WHO PS 0, 17 were PS 1 and 2 were PS 2 at the time of operation
  • At baseline the asymptomatic (PS 0) group scored 74.1 versus 53.8 in the symptomatic group, on a scale from 0 (very poor) to 100 (excellent)
  • PS 1 and 2 patients showed a modest but significant improvement in global health, all functional domains and symptom domains at 4 to 5 months, continuing to improve at 7 to 8 months
  • For PS 0 patients the Results section reports a decrease in global health, physical and role functioning, pain and dyspnea scores, while the Comment and abstract state they showed no decrease except in emotional function
  • PS 0 patients had a significant decrease in FEV1, FVC, TLC, FRC and DLCO; for example FEV1 fell from 84.11 to 72.4 and FVC from 80.2 to 67.1 percent predicted (abstract p values: FVC 0.001, FEV1 0.002, TLC 0.0006, DLCO 0.003)
  • PS 1 and PS 2 patients had no significant change in pulmonary function tests after EPD
  • Postoperative pulmonary function was similar in all patients regardless of preoperative performance status
  • No correlation was observed between changes in FEV1, FVC, TLC, FRC and DLCO and changes in quality-of-life scores, in the whole group or by performance status
• The authors' conclusion: The authors concluded that at intermediate follow-up EPD had a negative impact on lung function in minimally symptomatic patients without improving quality of life. In symptomatic patients it had no impact on lung function but significantly improved global health, symptom and functional scores. They suggested that preserved lung function may be partially responsible for this improvement.
• Limitations the authors state:
  • Relatively small sample size
  • Only patients able to complete the questionnaires and lung tests at follow-up were included, biasing toward patients who were doing well
  • Only one postoperative lung function measurement, not serial measurements
  • Effects of adjuvant chemotherapy and the psychological effect of a cancer diagnosis could not be separated from quality-of-life results

Topics

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

Medical terms in this study, explained in our Lexicon: Quality of Life, Pleural Mesothelioma, Cytoreductive Surgery, Extrapleural Pneumonectomy (EPP), Pulmonary Function Test (PFT), Performance Status, Total Lung Capacity (TLC), Diffusing Capacity (DLCO).

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• Quality of life after radical pleurectomy decortication for malignant pleural mesothelioma — N.M. Mollberg, Y. Vigneswaran, et al. (2012)
• Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma — T. Tanaka, S. Morishita, et al. (2017)
• A multicentre non-blinded randomised controlled trial to assess the impact of regular early specialist symptom control treatment on quality of life in malignant mesothelioma (RESPECT-MESO): study protocol for a randomised controlled trial — S. Gunatilake, F.J. Brims, et al. (2014)
• Exercise training to improve exercise capacity and quality of life in people with non-malignant dust-related respiratory diseases — M.T. Dale, Z.J. McKeough, et al. (2015)
• Physical function and health-related quality of life in the convalescent phase in surgically treated patients with malignant pleural mesothelioma — T. Tanaka, S. Morishita, et al. (2019)

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