V-179 Less-invasive approach for macroscopic complete resection in clinically early stage and low-volume malignant pleural mesothelioma

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.

Publication History

Article published online:
06 September 2021