Minimally Invasive Surgery for Mesothelioma is “Viable Alternative” to Standard Approaches

A new study from the Icahn School of Medicine at Mount Sinai in New York suggests that minimally invasive surgery for mesothelioma is a “viable alternative” to open-chest procedures. 

Both of the two main surgical procedures for pleural mesothelioma are usually done through a large incision in the chest. Both procedures also carry a high risk of post-surgical complications. 

But the New York researchers found that minimally invasive surgery for mesothelioma may produce fewer serious problems in the short-term. It may also give mesothelioma patients a better quality of life after surgery.

Surgical Treatment of Pleural Mesothelioma

Pleural mesothelioma tumors occur on tissue that surrounds the lungs. These tumors tend to spread out across the tissue in irregular shapes. Their size and shape makes them tricky to remove surgically. But people who have surgery for mesothelioma tend to live longer than those who don’t.

Minimally invasive surgery is when surgeons operate through a very small incision. They use a visualization tool to help them see inside the body while they operate. This approach can reduce blood loss, pain, and infection. 

But minimally invasive surgery for mesothelioma is rare. The two types of mesothelioma surgery are both complex and difficult. One of them (EPP) involves removing a lung. Right now, there is no way to make EPP less invasive. The other procedure (PD) leaves the lung intact but removes the pleura, large parts of the diaphragm, and other at-risk tissues. 

The Icahn School of Medicine team wanted to know if minimally invasive PD surgery for mesothelioma was really feasible, given its complexity. To do so, they evaluated the outcomes of mesothelioma patients who had different types of surgeries.

Evaluating Minimally Invasive Surgery for Mesothelioma

Video-assisted thoracoscopic surgery (VATS) is a method for minimally invasive surgery in the chest. VATS uses a camera called a thoracoscope to help surgeons see what they’re doing. VATS offers a minimally invasive way to do PD surgery.

The Icahn researchers evaluated the cases of mesothelioma patients in New York who had surgery between 2007 and 2017. One group included patients who had open surgeries (269 PD and 62 EPP). A second group included those who had PD, either open (269 patients) or via VATS (115 patients).

“Rates of any complication were similar between EPP and P/D patients, but EPP had significantly higher rates of cardiovascular complications,” writes Dong-Seok Lee, first author on the report. “After adjusting for confounders, those with a VATS approach were less likely to have any complication, compared to an open approach and significantly less likely to have a pulmonary complication.”

The researchers conclude that minimally invasive mesothelioma surgery with VATS “remains a viable alternative to radical surgery”. They say the approach gives mesothelioma patients improved short-term outcomes. 

VATS surgery for mesothelioma is typically only available at larger, more experienced cancer centers. It may be an option for people who are too sick or fragile for a more invasive procedure.

Source:

Lee, DS, et al, “VATS Pleurectomy Decortication Is a Reasonable Alternative for Higher Risk Patients in the Management of Malignant Pleural Mesothelioma: An Analysis of Short-Term Outcomes”, March 3, 2021, Cancers, Malignant Mesothelioma Special Issue, https://www.mdpi.com/2072-6694/13/5/1068/htm