Hintergrund
Macroscopic complete resection (MCR) is the goal of surgery for the multimodal
treatment of malignant pleural mesothelioma (MPM). Possibly due to systematic health
surveillance for former asbestos exposed worker, more patients might be diagnosed
with early stage and/or low-volume malignant pleural mesothelioma at our
institution. Based on experience in minimally-invasive thoracic debulking surgery
in
selected ovarian cancer patients, we adopted this approach to clinically early stage
and low-volume MPM patients. We report our first experience with less-invasive
technique for MPM.
Material und Methode
A video will demonstrate the surgical technique. We use one incision of 12 cm. No
rib
is excised. No rib spreader is used. One to two additional 1 cm ports for the camera
and instruments are placed whenever needed.
Ergebnis
Pleurectomy/decortication is performed by using a combination of conventional and
endoscopic instruments and techniques following the standardized surgical protocol
at our institution. Extensive visceral pleurectomy can be avoided using the
diode-pumped Nd:YAG Laser LIMAX® 120 (wavelength: 1318 nm, Gebrüder
Martin GmbH & Co KG, Tuttlingen, Germany) at a power output of 80 -100 watts
for tumor destruction of small spots on the visceral pleura. Partial resection of
the diaphragm and pericardium as well as reconstruction is carried out whenever
needed.
Schlussfolgerung
The goal of MCR might be accomplished less-invasively in clinically early stage and
low-volume MPM. Less-invasive surgery offers MPM patients the generally known
benefits as less morbidity, faster recovery and performance status preservation,
respectively.
