Extrapleural pneumonectomy for early stage malignant pleural mesothelioma: a harmful procedure

Area of Science:

• Thoracic Surgery
• Oncology
• Quality of Life Research

Background:

• Malignant pleural mesothelioma (MPM) is an aggressive cancer with limited treatment options.
• Surgical interventions like extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are employed for early-stage disease.
• Long-term outcomes regarding quality of life (QoL) and disease control after these procedures require further elucidation.

Purpose of the Study:

• To compare the long-term post-operative quality of life (QoL) and disease control between EPP and P/D in patients with early-stage MPM.
• To assess the impact of EPP versus P/D on patient-reported outcomes using the EORTC-QLQ-C30 questionnaire.

Main Methods:

• A retrospective analysis of 77 early-stage MPM patients who underwent either EPP (40) or P/D (37) between 1998 and 2009.
• QoL was assessed using the EORTC-QLQ-C30 questionnaire at baseline, 6, and 12 months post-treatment for 39 patients (19 EPP, 20 P/D).
• QoL evaluation was terminated upon disease recurrence.

Main Results:

• EPP was associated with a significantly higher rate of major in-hospital complications (62% vs 24%) and a higher surgical mortality (5% vs 0%) compared to P/D.
• Both procedures initially impaired QoL, but only P/D patients' QoL returned to baseline levels at 12 months post-treatment.
• EPP patients experienced worse long-term QoL, a shorter disease-free period (11 vs 14 months), and a shorter survival post-recurrence (9 vs 13 months) compared to P/D patients.

Conclusions:

• EPP in MPM patients results in a higher complication rate and poorer long-term QoL compared to P/D.
• P/D demonstrates a favorable profile in terms of QoL recovery and survival duration after recurrence, despite similar overall long-term survival.
• P/D may be a preferred surgical option for early-stage MPM when considering long-term patient well-being and outcomes.