Thoracic surgical problems in asbestos-related disorders

Our plain-English summary of Thoracic surgical problems in asbestos-related disorders, by E.A. Gaensler, T.C. McLoud, C.B. Carrington (The Annals of Thoracic Surgery, 1985).

The study

• Authors: E.A. Gaensler, T.C. McLoud, C.B. Carrington
• Journal: The Annals of Thoracic Surgery
• Published: 1985;40(1):82-96
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001223).

Abstract

Among 1,577 persons with asbestos exposure followed up from 3 to 30 years, 113 had thoracic surgical procedures for asbestos-related disorders. Twenty-six individuals suspected of having asbestosis with atypical features underwent open-lung biopsy; a different disease was revealed in 14. Most of the 29 patients with mesothelioma had a small thoracotomy for diagnosis only; chemotherapy in half of them proved entirely ineffective. Experience with 23 patients with bronchogenic carcinoma did not differ from that in persons not exposed to asbestos. Problems of causal relationship are discussed. Most of the 68 individuals with benign asbestos pleural effusion had no symptoms, but because of recurrence, 15 were operated on for decortication or for possible mesothelioma. Hyaline plaques often were mistaken for lung, rib, or diaphragmatic tumors, and sometimes mesothelioma was suspected. Operative intervention in the 24 patients with plaques could have been avoided by obtaining a more detailed occupational history and reviewing previous chest roentgenograms, which invariably showed identical or smaller plaques from 2 to 17 years earlier.

In plain English

This article, published as a 'Current Review', described the authors' records of 1,577 people exposed to asbestos: 342 seen clinically and 1,235 seen in surveys of asbestos factories and shipyards. Of 125 who had chest surgery, 113 had operations for asbestos-related disorders. Of 26 open-lung biopsies, 12 found asbestosis that had not been suspected. In 9 cases where asbestosis was suspected, other diseases were found. Of 168 people with pleural plaques, 24 had operations mainly because of the X-ray finding. Earlier X-rays were located for 21 of them and showed the plaques in every case, 2 to 17 years before. There were eight postoperative complications and one death, and the authors could discern no benefit. Of 68 people with benign asbestos pleural effusion, 15 had surgery. Among 29 pleural mesothelioma patients, 15 untreated patients survived an average of 15.8 months and 14 who received chemotherapy survived an average of 12.4 months. The authors judged their surgical experience with 23 lung cancer patients no different from lung cancer in general. They concluded that nearly all plaque operations could have been avoided.

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 the authors' own stored patient records (a case series of surgical patients), published under the heading 'Current Review'
• Who was studied: 1,577 asbestos-exposed persons: 342 seen in a clinical setting and 1,235 seen during industrial surveys. The surveys covered all employees of two asbestos paper factories, an electrical insulation plant and an asbestos products factory, plus high-risk groups in two shipyards. 125 of them had thoracic surgery.
• Exposure: Occupational asbestos exposure in asbestos paper factories, an electrical insulation plant, an asbestos products factory and shipyards. A few patients were exposed through household members. Fiber types were not specified for the patients studied.
• Main results:
  • Of 125 patients who had thoracic surgical procedures, 12 were operated on for unrelated disorders, leaving 113 with procedures for asbestos-related disorders.
  • 101 of the 1,577 exposed persons (6.4%) were thought to have asbestosis, and 26 had open-lung biopsy. In 12 patients in whom asbestosis was not suspected, biopsy showed varying degrees of asbestosis.
  • In 9 patients in whom asbestosis was suspected before surgery, biopsy found other disorders, such as sarcoidosis, acute alveolar injury, chronic passive congestion and amyloidosis.
  • 168 of the 1,577 exposed persons (10.7%) had hyaline plaques. Twenty-four of them (14.3%) were operated on mainly because of this X-ray abnormality.
  • Previous X-rays were obtained for 21 of the 24 plaque patients. In every one, the plaques were visible on earlier films, from at least 2 years and up to 17 years before the operation.
  • Among the 24 plaque operations there were eight postoperative complications, three of them serious, and 1 patient died of empyema and septicemia. The authors could discern no benefit from these operations.
  • Among plaque patients with earlier exposure, hospital records made no mention of that exposure in 10 of 13 cases.
  • 15 of 68 patients with benign asbestos pleural effusion were operated on. In those who had decortication, function was restored and there were no further effusions on the operated side.
  • During follow-up of the 15 operated effusion patients, 2 died of mesothelioma: one of a pleural lesion 9 years after decortication and one of an abdominal tumor 12 years after pleural biopsy.
  • Among 29 patients with pleural mesothelioma diagnosed at open thoracotomy, the 15 untreated patients survived an average of 15.8 months. The 14 treated with chemotherapy, sometimes with radiation, survived an average of 12.4 months.
  • All but 2 of the 29 mesothelioma patients gave a current or remote history of asbestos exposure.
  • Among 23 asbestos-exposed patients with bronchogenic carcinoma, all cigarette smokers, 3-year survival after resection was 77% (10 of 13) and 5-year survival was 63% (5 of 8).
  • The authors classed 10 of the 23 lung cancer patients, who had clinical asbestosis and first exposure more than 20 years earlier, as cases where lung cancer is attributable to asbestos. They saw no causal relationship in 5, and attributability was arguable in the remaining 8.
  • The authors found their surgical experience with lung cancer in asbestos-exposed patients no different from that reported for lung cancer in general.
• The authors' conclusion: The authors concluded that nearly all operations for plaques in their series could have been avoided by two measures: taking an exhaustive occupational history, and searching for previous chest X-rays.
• Limitations the authors state:
  • The authors stated that the lung cancer group was too small to justify sweeping conclusions.
  • The study pathologist preferred a diagnosis of adenocarcinoma in 6 of the 29 mesothelioma patients. These tumors were counted as mesotheliomas only because of their gross appearance.
  • Previous X-rays were often unavailable because they had been destroyed.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Biopsy, Mesothelioma, Thoracotomy, Chemotherapy, Bronchogenic Carcinoma, Benign Asbestos Pleural Effusion, Occupational History.

Related studies

• Asbestos-related diseases of lung and pleura: clinical picture and illustrative cases — B. Varkey, U.N. Kumar (1978)
• Common problems in asbestos-related pulmonary diseases — A.H. Rubin (1986)
• Surgical treatment of asbestos-related disease of the chest — L.P. Faber (1988)
• Effect of smoking on attack rates of pulmonary and pleural lesions related to exposure to asbestos dust — G.H. McMillan, R.J. Pethybridge, et al. (1980)
• Radiological changes in asbestos cement workers — K. Jakobsson, U. Strömberg, et al. (1995)
• Asbestos-related chest diseases: plain radiographic findings — W.T. Miller, W.B. Gefter, et al. (1992)

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