title: Effects of extended pleurectomy and decortication on quality of life and pulmonary function in patients with malignant pleural mesothelioma.
abstract: BACKGROUND
  Maximal cytoreductive surgeries--extrapleural pneumonectomy and extended pleurectomy and decortication (EPD)--are effective surgical treatments in selected patients with malignant pleural mesothelioma. Extended pleurectomy and decortication results in equivalent survival yet better health-related quality of life (HRQoL).
  
  
  METHODS
  Patients with malignant pleural mesothelioma were studied for the effects of EPD on HRQoL and pulmonary function. The European Organization for Research and Treatment of Cancer Core Quality of Life Questionaire-C30 was used to evaluate HRQoL before operation, and at 4 to 5 and 7 to 8 months postoperatively. Pulmonary function tests were measured immediately before and 5 to 7 months after the operation. Patients were compared according to World Health Organization baseline performance status (PS).
  
  
  RESULTS
  Of the 36 patients enrolled, 17 were PS 0 and 19 were PS 1 or PS 2 at baseline. Patients in groups PS 1 and PS 2 had significantly worse global health, functional, and symptoms scores. After EPD, PS 0 patients had no change in global health or function and symptoms scores except for emotional function, whereas PS 1 or PS 2 patients showed improvements at 4 to 5 months with further improvements at 7 to 8 months. The PS 0 patients demonstrated a significant decrease in forced vital capacity (p = 0.001), forced expiratory volume in 1 second (p = 0.002), total lung capacity (p = 0.0006) and diffusing capacity of the lung for carbon monoxide (p = 0.003) after EPD, whereas no change was observed in PS 1 and PS 2 patients.
  
  
  CONCLUSIONS
  Extended pleurectomy and decortication did not improve overall HRQoL and had a negative impact in pulmonary function in minimally symptomatic patients. In symptomatic patients, a significant improvement in HRQoL was observed after EPD, which continued at late follow-up, although the pulmonary function was not affected. As changes in HRQoL are multidimensional, the preservation of the pulmonary function may have contributed to the net benefit observed in PS 1 and PS 2 patients.
authors.affiliation: Division of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: David
authors.initials: D
authors.lastname: Burkholder
authors.affiliation: Division of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Duraid
authors.initials: D
authors.lastname: Hadi
authors.affiliation: Department of Biostatistics, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Rangesh
authors.initials: R
authors.lastname: Kunnavakkam
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Hedy
authors.initials: H
authors.lastname: Kindler
authors.affiliation: Division of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Kristy
authors.initials: K
authors.lastname: Todd
authors.affiliation: Division of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Amy Durkin
authors.initials: AD
authors.lastname: Celauro
authors.affiliation: Division of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois. Electronic address: wvignesw@surgery.bsd.uchicago.edu.
authors.forename: Wickii T
authors.initials: WT
authors.lastname: Vigneswaran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008175:Lung Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D008297:Male; D008654:Mesothelioma / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods*; D011788:Quality of Life; D020127:Recovery of Function; D012919:Social Behavior; D014109:Total Lung Capacity / Q000502:physiology; D016896:Treatment Outcome