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Symptomatic and quality of life changes after extrapleural pneumonectomy for malignant pleural mesothelioma
Author(s) -
Ambrogi Vincenzo,
Mineo Davide,
Gatti Antonio,
Pompeo Eugenio,
Mineo Tommaso C.
Publication year - 2009
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21261
Subject(s) - medicine , extrapleural pneumonectomy , mesothelioma , pneumonectomy , quality of life (healthcare) , surgery , pleural disease , radiation therapy , lung , respiratory disease , pathology , nursing
Background Extrapleural pneumonectomy for malignant pleural mesothelioma is considered an aggressive procedure, but symptomatic and quality of life changes are unknown. Methods Between 1997 and 2004, 16 consecutive patients underwent extrapleural pneumonectomy for mesothelioma followed by chemo‐radiotherapy. Tumor‐related symptoms and quality of life (Short‐Form‐36 and St. George's questionnaires) were assessed pre, 3, 6, 12, and 24 months postoperatively. Results Thirty‐day postoperative major morbidity was 31% with no mortality. At 3 months postoperatively, dyspnea improved in 10 patients (62%), pain in 12 (75%), cough in 10 (62%), fever in 11 (68%), Karnofsky‐index in 10 (62%), Short‐Form‐36 physical‐component‐summary in 8, mental‐component‐summary in 5 and total St. George score in 8 (50%). At 1 year 10 (62%) patients were alive and majority of improved parameters were still stable. Thereafter they usually started to decline. Survival was influenced by nonepithelial histology ( P < 0.01) and N2‐disease ( P < 0.01), which showed to be the only prognosticator at Cox regression ( P < 0.0001, Odd ratio 5.4). Among symptomatic variables, a 3‐month postoperative Short‐Form‐36 physical‐component‐summary above the median value correlated significantly with a better prognosis ( P < 0.02). Conclusions Extrapleural pneumonectomy may rapidly improve symptoms as well as quality of life, especially in physical domains. Other than biological factors, postoperative Short‐Form‐36 physical component as well, significantly influenced the prognosis. J. Surg. Oncol. 2009;100:199–204. © 2009 Wiley‐Liss, Inc.