VIDEOTHORACOSCOPY IN THE DIAGNOSIS AND TREATMENT OF MALIGNANT PLEURALMESOTHELIOMA WITH ASSOCIATED PLEURAL EFFUSIONS

Between 1985 and 1994 45 of 662 patients examined by thoracoscopy for secondary malignant pleural effusion were diagnosed to have diffuse ma lignant pleural mesothelioma. Mean patient age was 59 years, with a ma le: female ratio of 5:1. The right hemithorax was more frequently invo lved than the left (55% versus 45%). Pleural fluid cytology revealed m alignancy in 61.5% of cases. All patients were treated thoracoscopical ly by talc pleurodesis. Mean patient survival was 9.4 months. Survival after one, two, and 5 years was 37.5%, 12.5%, and 5%, respectively. T he characteristics of mesothelioma and pleural effusion evident in tho racoscopy and their diagnostic relevance are discussed. We suggest tal c instillation as the sole therapeutic maneuver in evolutioned cases, since the literature and our own experience indicate that survival is not significantly prolonged by more aggressive surgical approaches.