You undergo mesothelioma surgery with the expectation of living longer. Indeed, that’s the outcome many mesothelioma surgery patients enjoy.
But some mesothelioma surgery patients don’t survive as far into the future as they’d hoped. Two of the reasons for this were identified recently by researchers from Italy.
First reason: a post-surgical infection develops. Second reason: another serious medical condition is involved.
These findings appeared in the online edition of the European Journal of Cardiothoracic Surgery. They summarize research conducted by investigators from Italy’s University Hospital Borgo Trento in Verona and Humanitas Research Hospital near Milan.
“We examined a series of malignant pleural mesothelioma patients who underwent radical surgery to explore relationships among comorbidity, postoperative morbidity and survival,” they wrote.
EPP and P/D Mesothelioma Surgery Patients Studied
The retrospective study involved 163 malignant pleural mesothelioma patients who were treated between 2000 and 2015.
Of these patients, 91 received a particular form of mesothelioma surgery known as an extrapleural pneumonectomy (EPP).
Forty-seven of them received a different type of mesothelioma surgery — a pleurectomy/decortication (P/D). The remaining 25 received a palliative pleurectomy.
An EPP is intended to purge mesothelioma tumors by removing whichever of the two lung lobes has turned cancerous.
In addition to the lobe, the surgeon also removes some of the mesothelium that lines the chest and heart. Also taken out are the diaphragm and adjacent lymph nodes.
Patients are usually candidates for EPP if they are still in the early stages of mesothelioma. The benefit gained from EPP is that it can allow you to breathe with less difficulty.
By contrast, a P/D is a two-stage surgery where the lining that surrounds one lung is stripped away and then mesothelioma tumors are cut away from the chest cavity.
As with an EPP, you have to be in the early stages of mesothelioma to be considered for a P/D. The main benefit of a P/D is that you are left with both lungs intact.
A pleurectomy performed without the decortication (that’s the part where they cut away the tumors) is intended to minimize the presence of chest fluids and provide pain relief.
Mesothelioma, Comorbidity and Infection Connection Is Found
In this Italian study, some of these patients had comorbidities at the time of surgery. A comorbidity is a disease that exists alongside another illness. For example, a mesothelioma patient who also has diabetes has a comorbidity.
Other patients in this study developed a postoperative infection that resulted in pleural sepsis. Pleural sepsis is a cascading inflammatory response to the presence of infection in or near the lungs. Infection is one of the risks of mesothelioma surgery.
The resultant inflammatory response has the capacity to damage organs and weaken the body. That’s not particularly helpful if you’re trying to extend your years.
To perform this study, the researchers relied on a classification system called the Charlson Comorbidity Index. They also used a World Health Organization classification system to characterize the patients’ postoperative complications.
The researchers soon realized that there was a connection between postoperative survival longevity and the existence of comorbidities and postoperative infections.
They also noticed that postoperative infections struck patients who underwent EPP six times more often than they did those who received P/D.
“The Charlson Comorbidity Index is an independent predictor of survival in malignant pleural mesothelioma patients undergoing radical surgery,” they wrote. “Owing to its significant frequency and adverse impact, pleural sepsis may contribute to a reduced life expectancy after EPP.”
The title of the study is “Comorbidity, Postoperative Morbidity and Survival in Patients Undergoing Radical Surgery for Malignant Pleural Mesothelioma.”