Quantitative Measurement of Lung Reexpansion in Malignant Pleural Mesothelioma Patients Undergoing Pleurectomy/Decortication

Abstract

Malignant pleural mesothelioma (MPM) is a neoplasm that grows circumferentially along the pleura. The tumor and concurrent pleural effusion may reduce lung function by restricting or preventing lung expansion. The purpose of this study was to provide objective evidence that pleurectomy/decortication (P/D) allows trapped lung to reexpand, quantify the reexpansion based on computed tomography (CT) scans, and investigate whether the expansion persists after surgery. A database of 12 patients demonstrating unilateral MPM was collected. Each patient underwent a presurgical CT scan, surgical debulking by P/D, and two postsurgical CT scans (at 1 and 4 months). The lung volume was measured in each scan using an automated algorithm and compared for each patient across time. An increase in the ipsilateral postsurgical lung volume was observed for 10 of 12 patients (83%) 1 month after surgery. The median ipsilateral volume increase was 44% relative to the presurgical ipsilateral volume and 21% relative to the contralateral volume. A statistically significant change in ipsilateral lung volume was not observed between 1‑month and 4‑month postsurgical scans, implying that the volume improvement persisted months after surgery. Debulking of MPM with P/D substantially increased the ipsilateral lung volume relative to both the presurgical ipsilateral volume and the contralateral lung volume. This improvement persisted months after surgery.