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Eur J Cardiothorac Surg 2006;29:579-584
© 2006 Elsevier Science NL

Incidence and management of complications after neoadjuvant chemotherapy followed by extrapleural pneumonectomy for malignant pleural mesothelioma

^a Division of Thoracic Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
^b Division of Oncology, University Hospital Zurich, Switzerland
^c Institute for Biostatistics and Preventive Medicine, Switzerland

Received 23 September 2005; received in revised form 26 December 2005; accepted 10 January 2006.

^_* Corresponding author. Tel.: +41 44 255 8802; fax: +41 44 255 8805. (Email: walter.weder{at}usz.ch).

Objective: To investigate the incidence and management of postoperative complications after neoadjuvant chemotherapy followed by extrapleural pneumonectomy for malignant pleural mesothelioma. Methods: Patients with histologically proven mesothelioma of clinical stages T1–3, N0–2, M0 and considered to be completely resectable received neoadjuvant chemotherapy (cisplatin + gemcitabine or cisplatin + pemetrexed) followed by extrapleural pneumonectomy and postoperative radiotherapy. The incidence and management of postoperative complications in general and of bronchopleural fistula and postpneumonectomy-empyema in particular were analyzed. Univariate analysis was performed to identify prognostic factors [sex, age, side of operation, weight loss, smoking, chemotherapy, EORTC-score (European Organization for Research and Treatment of Cancer-classification) and duration of operation]. Results: Between 1st May 1999 and 15th August 2005, 63 patients underwent complete extrapleural pneumonectomy after neoadjuvant chemotherapy. Postoperative complications were observed in 39 cases (62%) and 2 patients died within 30 days (3.2%). Postpneumonectomy-empyema occurred in 15.8% of the patients (n = 10), six with a bronchopleural fistula on the right side. All empyemas were treated successfully. Five patients developed chylothorax (7.9%) and four patients had complications due to a patch failure: cardiac herniation (n = 2), restriction of cardiac output (n = 1) or gastric herniation (n = 1). Patients with higher EORTC-score presented significantly more postoperative complications (p = 0.03). A longer duration of surgery tended to be associated with a higher incidence of postoperative complications, especially of empyemas. Conclusions: Extrapleural pneumonectomy after neoadjuvant chemotherapy can be performed with mortality rates comparable to standard pneumonectomies. Complications are frequent but can be successfully managed; the EORTC-score seems to be a predictor for postoperative complications.

Key Words: Extrapleural pneumonectomy • Complications • Neoadjuvant chemotherapy • Malignant pleural mesothelioma • EORTC-score

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