Prospective study on functional results after lung-sparing radical pleurectomy in the management of malignant pleural mesothelioma

Our plain-English summary of Prospective study on functional results after lung-sparing radical pleurectomy in the management of malignant pleural mesothelioma, by S. Bölükbas, M. Eberlein, J. Schirren (Journal of Thoracic Oncology, 2012).

The study

• Authors: S. Bölükbas, M. Eberlein, J. Schirren
• Journal: Journal of Thoracic Oncology
• Published: 2012;7(5):900-5
• Cited by: 42 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Malignant pleural mesothelioma (MPM) can reduce lung function by entrapping lung parenchyma via a rind of tumor with or without concurrent effusion. Radical pleurectomy (RP) allows expansion of the trapped lung. The purpose of this study was to investigate changes in pulmonary function and lung perfusion in patients undergoing RP.

Methods: In a prospective, nonrandomized study, all patients with histologically proven MPM were evaluated from January to December 2010 for trimodality therapy including RP as surgical procedure. Pulmonary-function tests and perfusion scans were obtained before and 2 months after RP. Primary end points were pulmonary function (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1]) and ipsilateral lung perfusion.

Results: Sixteen out of 25 consecutive patients (age 68.8±8.9 years) were enrolled in the study. Macroscopic complete resection could be achieved in 13 patients (81.3%). Diaphragm resection was necessary in 5 patients. Significant postsurgical improvement of pulmonary function at 2 months was observed for FVC and FEV1 (both absolute and percentage of predicted values) and ipsilateral perfusion (p < 0.001). Avoidance of diaphragm resection was associated with greater increase in FVC (+34.6±17.0% versus +13.5±5.4%; p = 0.002) and FEV1 (+29.2±18.1% versus +12.1±6.4%; p = 0.015), respectively.

Conclusions: Lung-sparing RP leads to significant improvement of pulmonary function and perfusion after a recovery time of 2 months. Functional results are better after preservation of the diaphragm. Preservation of physiological reserve via lung-sparing RP might allow patients with MPM to be eligible for further therapeutic options in the long term.

In plain English

This prospective, nonrandomized study at one thoracic surgery department in Wiesbaden, Germany, measured how lung-sparing radical pleurectomy affected breathing and blood flow to the lung in patients with malignant pleural mesothelioma. Of 25 patients referred in 2010, 16 (14 men, mean age 68.8 years) had the operation within a planned treatment that also included chemotherapy and chest-wall radiation. Lung tests and perfusion scans were done before surgery and 2 months after. The article does not describe the patients' asbestos exposure. Mean forced vital capacity (FVC) rose from 54.7% to 68.9% of predicted, FEV1 rose from 60.2% to 73.6% of predicted, and perfusion of the operated-side lung rose from 29.2% to 38.5% (all p less than 0.001). Complications occurred in 7 of 16 patients, and none died. The 5 patients who needed diaphragm resection had smaller gains in FVC and FEV1 than those who did not. The authors concluded that the surgery significantly improved lung function and perfusion at 2 months. They cautioned that with so few patients the differences could be due to chance, and that long-term effects were not answered.

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: Prospective, nonrandomized single-center study (described by the authors as a pilot study) comparing lung function and lung perfusion before and 2 months after surgery
• Who was studied: 16 patients with histologically confirmed malignant pleural mesothelioma (14 men; mean age 68.8 ± 8.9 years), out of 25 referred to a single tertiary referral center (Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany) from January to December 2010. 12 had IMIG stage III/IV disease, and 87.5% had epithelial histology.
• Exposure: The article studied a treatment, not asbestos exposure: lung-sparing radical pleurectomy (removal of the visceral and parietal pleura while preserving the lung) within trimodality therapy, followed by four cycles of cisplatin/pemetrexed and chest-wall radiation. No asbestos exposure information is reported.
• Main results:
  • In all 16 patients, postoperative mean FVC was 68.9% of predicted (preoperative 54.7%) and mean FEV1 was 73.6% of predicted (preoperative 60.2%). Ipsilateral lung perfusion rose from 29.2% to 38.5%. All of these changes had p less than 0.001. The authors described this as improvement from a moderate to a mild restrictive ventilatory defect.
  • Average relative increases across the 16 patients: FVC +28.0% (range +3.5% to +59.0%), FEV1 +23.9% (+1.5% to +61.5%), and perfusion +37.8% (+8.7% to +150.0%).
  • 13 of 16 patients (81.3%) had an improvement of 10% or more in FEV1 (% predicted).
  • Compared with the 5 patients who had diaphragm resection, patients who avoided it had greater increases in FVC (+34.6% ± 17.0% versus +13.5% ± 5.4%; p = 0.002) and in FEV1 (+29.2% ± 18.1% versus +12.1 ± 6.4%; p = 0.015). Diaphragm resection had no significant effect on lung perfusion.
  • Surgical complications occurred in 7 of 16 patients (43.8%), and no patients died.
  • In linear regression, a lower preoperative FVC or FEV1 (% predicted) was associated with a higher relative increase after surgery (p less than 0.02 for both).
• The authors' conclusion: The authors concluded that lung-sparing radical pleurectomy leads to significant improvement of pulmonary function and perfusion after 2 months of recovery, and that functional results are better when the diaphragm is preserved.
• Limitations the authors state:
  • Because of the small number of patients, the differences found could be due to chance, and the results need confirmation in a larger study.
  • The study did not answer whether the improvements persist in the long term. Function was measured only at 2 months.
  • Pleural fluid reaccumulated rapidly in all patients between thoracoscopy and surgery, which might have biased the measured changes.
  • Smoking cessation and intensive chest physiotherapy around surgery were confounding factors that might have influenced the results.
  • Quality of life was not evaluated.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Parenchyma, Trapped Lung, Trimodality Therapy, FEV1, Diaphragm.

Related studies

• Factors predicting poor survival after lung-sparing radical pleurectomy of IMIG stage III malignant pleural mesothelioma — S. Bölükbas, M. Eberlein, et al. (2013)
• Survival after trimodality therapy for malignant pleural mesothelioma: Radical Pleurectomy, chemotherapy with Cisplatin/Pemetrexed and radiotherapy — S. Bölükbas, C. Manegold, et al. (2011)
• Which is the Role of Pneumonectomy in the Era of Parenchymal-Sparing Procedures? Early/Long-Term Survival and Functional Results of a Single-Center Experience — A. Janet-Vendroux, M. Loi, et al. (2015)
• Quality of life after radical pleurectomy decortication for malignant pleural mesothelioma — N.M. Mollberg, Y. Vigneswaran, et al. (2012)
• Long-term survival after lung-sparing total pleurectomy for locally advanced (International Mesothelioma Interest Group Stage T3-T4) non-sarcomatoid malignant pleural mesothelioma — A. Nakas, E. von Meyenfeldt, et al. (2012)
• Disease-Related Outcomes and Toxicities of Intensity Modulated Radiation Therapy After Lung-Sparing Pleurectomy for Malignant Pleural Mesothelioma: A Systematic Review — R. Patel, E.B. Ludmir, et al. (2020)

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