Mesothelioma - VATS biopsy and lung mobilization improves diagnosis and palliation

Objectives: Mesothelioma is an increasingly frequent malignancy in which di agnosis is often delayed and disease diagnosed at an advanced stage. Earlie r diagnosis and therapeutic intervention that can control recurrent pleural effusion may improve outlook and survival. Methods: A prospective series o f 25 patients in whom mesothelioma was suspected was referred for histologi cal diagnosis by video assisted-thoracoscopy (VAT) after failure of other m ethods. At the same operative procedure drainage of pleural effusion, cytor eductive pleurectomy and lung mobilization was performed where possible. Co mplete follow-up was obtained. Results: All patients had a histological dia gnosis (100%) from the material sent for biopsy. In 23 patients this was me sothelioma, in two patients chronic empyema. All patients undergoing draina ge of effusion, cytoreductive pleurectomy and lung mobilization subsequentl y were diagnosed of having mesothelioma stages III to IV. Fifteen out of 21 who underwent lung mobilization had closure of the pleural space. Post ope rative air leak in this group was a mean of 5 days (2-12 days). Recurrent e ffusion occurred in only one patient. Eleven patients remain alive at 1-2 y ears post operation with no hospital admissions for recurrent pleural effus ion. In the six out of 21 who did not have closure of the pleural space, on e remained alive 9 months post surgery. Five died within 1-6 months of the procedure. The average number of further hospital admissions for repeat dra inage of effusion was 3 (1-6). Conclusions: VATs provides adequate tissue f or histological diagnosis where other methods fail. At the same operative s itting it provides a therapeutic intervention that allows drainage of effus ion cytoreductive pleurectomy and lung mobilization in a significant number of cases. Where the pleural space can be closed this results in significan tly fewer hospital admissions and appears to improve quality of life and le ngth of survival. The price is a longer hospital stay due to prolonged air leak. (C) 1999 Elsevier Science B.V. All rights reserved.