title: Symptomatic and quality of life changes after extrapleural pneumonectomy for malignant pleural mesothelioma.
abstract: 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.
authors.affiliation: Thoracic Surgery Division, Policlinico Tor Vergata University, Rome 00133, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ambrogi
authors.forename: Davide
authors.initials: D
authors.lastname: Mineo
authors.forename: Antonio
authors.initials: A
authors.lastname: Gatti
authors.forename: Eugenio
authors.initials: E
authors.lastname: Pompeo
authors.forename: Tommaso C
authors.initials: TC
authors.lastname: Mineo
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D003371:Cough / Q000209:etiology / Q000628:therapy; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D005260:Female; D005334:Fever / Q000209:etiology / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011013:Pneumonectomy; D011379:Prognosis; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant