Complication from extra-pleural pneumonectomy

Extra-plueral pneumonectomy is a radical surgical option for mesothelioma patients. Unlike pleurectomy/decortication surgery, which leaves the lung intact, the removal of the affected lung can have serious complications in addition to reduced quality of life and lack of mobility associated with only having a single functioning lung. The following abstract reports on one such complication.

1: J Thorac Oncol. 2007 Jul;2(7):673-5

Constrictive pericarditis after left extrapleural pneumonectomy and radiotherapy for malignant mesothelioma.
Hickey EJ, Khan AA, Chambers JB, Lang-Lazdunski L.

The Hospital for Sick Children, Toronto, Ontario, Canada.

We report the devastating complication of constrictive pericarditis after multimodality therapy including left extrapleural pneumonectomy for malignant pleural mesothelioma. The patient presented with progressive dyspnea, ascites, and peripheral edema 6 months after receiving adjuvant radiotherapy. A diagnosis of constrictive pericarditis was made late in the clinical course after exhaustive investigation to exclude primary disease recurrence. Pericardial decortication was subsequently undertaken 12 months after the initial surgery, but the patient died of multi-organ failure. Our experience, combined with a review of the available literature, leads us to advise a low level of suspicion and early operation to relieve cardiac constriction. Furthermore, these complications emphasize the importance of trials such as the Mesothelioma and Radical Surgery (MARS) study.
PMID: 17607128 [PubMed – in process]

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