29.10.2020 | Thoracic Oncology
Complications and Predictive Factors for Air Leak > 10 Days with Neoadjuvant Chemotherapy Followed by Pleurectomy/Decortication for Malignant Pleural Mesothelioma
verfasst von:
Akifumi Nakamura, MD, Nobuyuki Kondo, MD, PhD, Toru Nakamichi, MD, Masaki Hashimoto, MD, PhD, Teruhisa Takuwa, MD, PhD, Seiji Matsumoto, MD, PhD, Kozo Kuribayashi, MD, PhD, Takashi Kijima, MD, PhD, Seiki Hasegawa, MD, PhD
Erschienen in:
Annals of Surgical Oncology
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Ausgabe 6/2021
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Abstract
Background
A few studies have reported the incidence and clinical implications of complications after pleurectomy/decortication (P/D).
Objective
The aim of this study was to assess the details of complications and predictive factors of particularly durable air leak with P/D.
Methods
Data on 163 consecutive patients who underwent neoadjuvant chemotherapy (NAC) followed by P/D for malignant pleural mesothelioma between September 2012 and May 2020 at our institution were retrospectively analyzed. Postoperative complications and the significance of various preoperative risk factors for air leak > 10 days (AL10) to identify the group having a higher risk for particularly durable air leak were investigated. Risk factors for AL10 were sought using univariate and multivariate analyses.
Results
Of 163 patients, 30- and 90-day mortality was 0.6% and 2.5%, respectively. Eighty-four (51.4%) patients experienced grade III or worse postoperative complications according to the Clavien–Dindo classification. The median duration of air leak was 7 postoperative days. AL10 occurred in 53 (32.5%) patients. Fifty-eight patients (35.6%) underwent pleurodesis and five patients (3.1%) underwent reoperation to control the air leak. On univariate analysis, performance status (PS; p = 0.003), prognostic nutritional index (p = 0.01), and pleural effusion (p = 0.04) were statistically significant risk factors for AL10, while on multivariate analysis, PS (odds ratio 4.0, 95% confidence interval 1.3–12.7; p = 0.02) remained the only variable predicted for AL10.
Conclusions
Recent postoperative mortality rates in NAC followed by P/D are quite acceptable. Approximately one in every three patients experienced AL10, and PS may be a risk factor associated with AL10.