V-178 Diode-Pumped Laser for Lung-Sparing Surgical Treatment of Malignant Pleural Mesothelioma – Single-Surgeon Experience

Hintergrund

Whenever tumor infiltration of the lung parenchyma is present, anatomical or atypical resections are often required to achieve macroscopic complete resection for the surgical treatment of malignant pleural mesothelioma (MPM). In the current work, the single-surgeon experience with the application of diode-pumped laser for surgical treatment of MPM is reported.

Material und Methode

Between 12/2014 and 12/2020, all patients with MPM undergoing surgical therapy, where a diode-pumped laser for lung-sparing resection was utilized, were included in the current analysis. Data was collected prospectively and analyzed in a retrospective fashion.

Ergebnis

A total of 18 patients (four female) with a mean age of 66 (40–84) years were included in the analysis. All patients underwent standardized extended pleurectomy/decortication with systematic radical lymph node dissection. In all patients, tumor infiltration of the basilar lower lobe was present. Here, a diode-pumped neodymium-doped yttrium aluminium garnet laser was utilized for parenchyma-sparing lung resection. Macroscopic complete resection could be achieved in all patients. Heated-intraoperative chemotherapy was not performed in any patient. Laser-related morbidity or mortality did not occur. Despite the pre-surgical diagnosis, 5 out of 18 histologies were classified as non-epitheloid (4 biphasic, 1 sarcomatoid). The most common postoperative stages were IA in nine and stage IIIB in five patients, respectively. All patients underwent adjuvant chemotherapy with cisplatin/carboplatin and pemetrexed. Seven patients received immunotherapy in event of recurrence. Patients with epitheloid histology (n=13) had superior outcomes in terms of median survival (35 [95%CI 23-47] vs. 10 months [95%CI 8-12], P=0.012), median progression-free survival (15 [95%CI 4-26] vs. 9 months [95%CI 3-15], P=0.067]), respectively.

Schlussfolgerung

The above-mentioned surgical technique applying the diode-pumped laser represents a safe and effective method for parenchyma-sparing lung resection during surgery for MPM when lung infiltration is present. The outcomes are promising for patients with epitheloid histology. However, pre-surgical tissue diagnosis should be more reliable to avoid futile surgery in patients with non-epitheloid MPM.

Publication History

Article published online:
06 September 2021