Complications
The risk of developing a complication after extra-pleural pneumonectomy is high, even in experienced centres.[57] Common complications include atrial fibrillation, prolonged intubation, vocal cord paralysis, and deep vein thrombosis.
Fewer complications have been noted after pleurectomy with decortication.
Patients can develop several adverse effects during radiotherapy, including erythema of the skin, increased pain along a thoracotomy scar, odynophagia as a result of oesophagitis, nausea and vomiting, and fatigue.
After extra-pleural pneumonectomy, excessive radiation dose to the contralateral lung can lead to radiation pneumonitis, a condition characterised by shortness of breath, dry cough, and low-grade fevers occurring 1 to 6 months after completing radiotherapy.
Severe cases can be fatal.[74] The incidence of fatal pulmonary toxicity after radiotherapy (intensity-modulated radiotherapy) has varied between 10% and 46% and is closely related with dose volume parameters.[74][98][99] Restricting the dose to the contralateral lung is imperative.
Corticosteroids, usually prednisolone, are the mainstay of treatment.
Radiotherapy after pleurectomy with decortication is not recommended, in part due to high rates of radiation pneumonitis.[76]
Haematological toxicity is the most common adverse effect from treatment with cisplatin and pemetrexed, particularly if vitamin supplementation is not given (B12 and folic acid).[100]
The incidence of postoperative mortality after extra-pleural pneumonectomy (EPP) ranges from 4% to 15% at 30 days post-surgery, whereas the incidence of postoperative mortality after pleurectomy with decortication is about 4% 30 days post-surgery.[56][57][58]
Pulmonary embolism is the most common cause of operative mortality.[57]
Given the complexity of EPP, this procedure should be performed by experienced surgeons in hospitals that are equipped to manage the many complications that can develop.[57]
Patients with inoperable or recurrent disease have a high risk of local disease progression, as do patients with operable disease treated with surgery alone. Consequently, dysphagia, hoarseness, cord compression, brachial plexopathy, Horner's syndrome, and superior vena cava syndrome can occur.
Metastases to the opposite lung, brain, and abdominal cavity may occur. Other extra-thoracic sites can also be affected.
If extension to the abdominal cavity occurs, ascites can develop with consequent abdominal distension and/or pain.
Use of this content is subject to our disclaimer