Multifactorial Evaluation following Cytoreductive Surgery for Malignant Pleural Mesothelioma in Patients with High Symptom-Burden

Mesothelioma has a scant prognosis and a great impact on symptoms and the quality of life. Pleurectomy/decortication and extrapleural pneumonectomy are the two cytoreductive surgical strategies, with different invasiveness, but achieving similar oncological results. Hereafter, the two surgical procedures effects on symptoms and the quality of life are compared in a high symptom-burden population. Between 2003 and 2017, 55 consecutive patients underwent pleurectomy/decortication (n = 26) or extrapleural pneumonectomy (n = 29), both followed by adjuvant chemo-radiotherapy. Cardio-pulmonary function, symptoms and the quality of life (Short-Form-36 and St.George's questionnaires) were evaluated pre- and 3-, 6-, 12- and 24-months postoperatively. Extrapleural pneumonectomy demonstrated lower pain at 12 months but a higher decrement of forced vital capacity at 24 months than pleurectomy/decortication. Both procedures revealed a 3-months improvement of many symptoms and the quality of life determinants. Improvement in physical, social and pain-related measured parameters lasted for a longer time-spawn in the extrapleural pneumonectomy group. No differences were found in chemotherapy compliance and survival between groups. Age-at-presentation (p = 0.02) and non-epitheliod histology (p = 0.10) were the only significant prognosticators. Surgery, despite poor survival results, improved symptoms and the quality of life in patients with mesothelioma with high symptom-burden at diagnosis. Therefore, extrapleural pneumonectomy demonstrated the most durable effects.

Automated summary

This study compared the effects of pleurectomy/decortication and extrapleural pneumonectomy on symptoms and quality of life in patients with high symptom burden mesothelioma. The results showed that while extrapleural pneumonectomy had lower pain at 12 months, it had a higher decrement of forced vital capacity at 24 months compared to pleurectomy/decortication. Both procedures improved many symptoms and quality of life determinants at 3 months, but the improvement lasted longer in the extrapleural pneumonectomy group. There were no differences in chemotherapy compliance and survival between the two groups. Age at presentation and non-epitheliod histology were the only significant prognosticators. These findings suggest that surgery can improve symptoms and quality of life in patients with high symptom burden mesothelioma, with extrapleural pneumonectomy having the most durable effects.