Complications
The risk of developing a complication after extrapleural pneumonectomy is high, even in experienced centers.[68] 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 radiation therapy, including erythema of the skin, increased pain along a thoracotomy scar, odynophagia as a result of esophagitis, nausea and vomiting, and fatigue.
After extrapleural pneumonectomy, excessive radiation dose to the contralateral lung can lead to radiation pneumonitis, a condition characterized by shortness of breath, dry cough, and low-grade fevers occurring 1-6 months after completing radiation therapy.
Severe cases can be fatal.[89] The incidence of fatal pulmonary toxicity after radiation therapy (intensity-modulated radiation therapy) has varied between 10% and 46% and is closely related with dose volume parameters.[89][109][110] Restricting the dose to the contralateral lung is imperative.
Corticosteroids, usually prednisone, are the mainstay of treatment.
Comprehensive radiation therapy after pleurectomy with decortication is generally not recommended due to the risk of radiation pneumonitis.[47][94][95]
Hematologic toxicity is the most common adverse effect from treatment with cisplatin and pemetrexed, particularly if vitamin supplementation is not given (B12 and folic acid).[111]
The incidence of postoperative mortality after extrapleural pneumonectomy (EPP) ranges from 4% to 15% at 30 days post-surgery; incidence of postoperative mortality after pleurectomy with decortication is about 4% 30 days post-surgery.[67][68][69]
Pulmonary embolism is the most common cause of operative mortality.[68]
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.[68]
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 syndrome, and superior vena cava syndrome can occur.
Metastases to the opposite lung, to the brain, and to the abdominal cavity may occur. Other extrathoracic sites can be affected.
If extension to the abdominal cavity occurs, ascites can develop with consequent abdominal distention and/or pain.
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