Complications following radical surgery for malignant pleural mesothelioma—prevention and management

Radical surgery for malignant pleural mesothelioma (MPM) is a major undertaking for any patient and whilst it cannot be assumed to lead to a cure from the disease it is performed with the intent of prolonging survival. The surgical techniques used are either extra-pleural pneumonectomy (EPP) or extended pleurectomy/decortication (EPD). Patients undergoing EPD surgery have a lower short-term mortality compared to those undergoing EPP surgery. The better perioperative mortality has led to a recent trend towards preference to EPD, whenever possible. The prompt treatment of post-operative complications, may improve the patients survival, therefore, heightened awareness of their possibility and where possible preventive measures should be employed. Complications following surgery for MPM can be considered in three categories—pleuropulmonary: parenchymal atelectasis, pneumonia, pulmonary oedema, acute respiratory distress syndrome (ARDS), bronchopleural fistula (BPF), persistent air leak and pleural empyema—cardiovascular: post-operative hypotension, arrhythmias, cardiac herniation and pulmonary embolism (PE)—technical: haemothorax, chylothorax, prosthetic patch dehiscence and oesophagopleural fistula. We discuss the early warning signs, preventative actions and management strategies.