July 16, 2004 — A recent study analyzed the complications of using the surgical procedure, extrapleural pneumonectomy, on mesothelioma patients (J Thorac Cardiovasc Surg. 2004 Jul; 128(1): 138–46). In an extrapleural pneumonectomy, the surgeon removes portions of the patient’s lung, parietal pleura (the lining of the lung), the pericardium (the lining of the heart), and the diaphragm. This surgery is usually limited to the earlier stages of mesothelioma when the tumor has not spread to the lymph nodes. Its purpose is to eliminate as many cancer cells as possible.
Out of 328 patients who received extrapleural pneumonectomies between 1980 and 2000, 128 experienced complications, and 11 died during or soon after surgery. The most common problem was atrial fibrillation, a rapid, irregular contraction of the upper heart chamber that can block the heart from pumping blood properly. Other side effects included: vocal cord paralysis, serious blood clots or thrombosis, renal problems, respiratory distress, and a condition known as “tamponade,” which is excess fluid in the sac surrounding the heart.
The mortality rate in this study was 3.4%. This is down from 15% when extrapleural pneumonectomies were first performed on mesothelioma patients. The study authors believe that early detection and aggressive measures can minimize death rates from the extrapleural pneumonectomy operation itself. They suggest procedures such as CT scans to detect thrombosis, open heart massage to relieve tamponade, and immediate injection of the vocal cords with a gel foam when vocal cord paralysis is diagnosed. They are researching special precautions to be taken to prevent atrial fibrillation.
Some studies suggest that a mesothelioma patient who survives the rigors of an extrapleural pneumonectomy may be rewarded by a better quality of life due to improved breathing and mobility. The extrapleural pneumonectomy may also slow the progress of the disease. Those in the early stages of mesothelioma seem to respond best to the operation. Survival chances also increase if the tumors involved are epithelial, which is a common cell type that is cube–shaped and uniform. See Research on Surgery in Treating Mesothelioma for more details.
Doctors may prescribe pemetrexed (Alimta®) to patients with more advanced mesothelioma who are not considered good candidates for surgery. The Food and Drug Administration recently approved a combination of pemetrexed plus a standard chemotherapy agent, cisplatin, to treat patients with pleural mesothelioma. The pemetrexed/cisplatin combination can prolong life and improve lung function. See FDA Approves Sale of Mesothelioma Drug.
Brayton Purcell has been handling cases involving mesothelioma and asbestos exposure for over 20 years. We understand that facing a mesothelioma diagnosis is difficult, and requires support, information, and advocacy. If you or a family member has been diagnosed with mesothelioma, please feel free to contact us to learn about resources and your legal options.
