Current Thoracic Surgery 2019 , Vol 4 , Issue 3
Sustained preservation of pulmonary function after pleurectomy/ decortication: should it be the main reason to perform surgery in malignant pleural mesothelioma patients?
Simge Ozer1,Serdar Ince1,Tugce Sevval Koyi1,Aslihan Cikmazkara1,Sevim Gulsen Ozeren1,Zeynep Bilgi2,Hasan Fevzi Batirel1
1Department of Thoracic Surgery, Marmara University, School of Medicine, Istanbul, Turkey
2Department of Thoracic Surgery, Medeniyet University, School of Medicine, Istanbul, Turkey
DOI : 10.26663/cts.2019.00123 Viewed : 4588 - Downloaded : 1202 Background: Pleurectomy/decortication for malignant pleural mesothelioma is performed to improve survival and pulmonary function. Our aim was to analyze pulmonary function outcomes following pleurectomy/decortication.

Materials and Methods: 95 patients underwent pleurectomy/decortication for mesothelioma between years 2005-2016. 30 patients were alive at the time of analysis. Three patients were not fit to perform spirometry and three patients were living in rural areas. In 24 patients, spirometry was performed and compared with preoperative values. Demographic data, side, surgical technique, histology, recurrence, FEV1 (% and L), FVC (% and L), change in FEV1 and FVC were recorded and analyzed. A control group (n = 9) was formed with lung cancer patients who underwent lower lobectomy.

Results: Average age was 56 ± 10 years (26-75). 13 extended and 11 partial pleurectomy/decortications were performed. Average hospital stay was 6.9 ± 3.4 days. 21 patients had epithelioid and 13 had T3-4 tumors. 23 patients had adjuvant chemotherapy, while 7 had adjuvant high dose radiation. Median survival was 31 months (6.4 - 83). Average preoperative and recent FEV1 (L) were 2.18 ± 0.82 and 1.84 ± 0.61 respectively (p = 0.004). The values were slightly higher for lower lobectomy patients. Average percentage change in FEV1 was -11.5 ± 23 which was very similar with control group (-12.4 ± 15). In 6 MPM patients, recent FEV1 (L) was higher than preoperative.

Conclusions: Pleurectomy/decortication results in stable or improved pulmonary function in 40% of the patients independent of survival. The change in FEV1 is identical with lower lobectomy patients. Pleurectomy/decortication should be the preferred technique in resectable mesothelioma patients. Keywords : malignant pleural mesothelioma, pulmonary function, pleurectomy/decortication