The end stages of mesothelioma usually cause patients to feel unwell, and their therapeutic options are limited. Open surgery is too risky, and a palliative surgery has limited value.
Enter the VATS-pleurectomy with decortication (P/D).
This is a minimally invasive version of P/D, which is usually a surgery to remove areas of the thorax. Doctors open the patient’s chest region to remove the lining near the lungs, plus the diaphragm and pericardium.
VATS-P/D is a much more subdued form, using a needle-like incision to drain fluid and remove small amounts of tumors from the lung lining. Dr. Raja Flores, the chief thoracic surgeon and mesothelioma specialist at Mount Sinai Medical Center in New York, was part of the study.
Help is available if you or a loved one has malignant mesothelioma. Contact our medical expert Karen Ritter at firstname.lastname@example.org. She can help you find a cancer center that offers palliative treatments like VATS-P/D, pleurodesis or thoracoscopy.
Explaining VATS-P/D for Mesothelioma
VATS is the acronym for “video-assisted thoracoscopic surgery.” It uses a small camera attached to a thoracoscope, a viewing tube, for a first-hand look inside the patient’s chest. VATS is helpful for diagnosing pleural mesothelioma, but doctors also use it to remove tumors near the incision site.
Since the surgery involves a small incision rather than a large one, there are few complications for patients. Elderly patients, late-stage patients and sick patients can benefit from this approach versus open P/D surgery.
Dr. Flores explained VATS-P/D doesn’t have the survival rates of normal open-surgery P/D, or EPP. For these patients, there must be a balance between removing tumors, reducing symptoms, and avoiding major surgical complications.
Stats for VATS-P/D
In the analysis, 384 patients had P/D: 269 had open P/D; and 115 had VATS-P/D. The minimally invasive approach led to far fewer lung-related (pulmonary) complications.
VATS-P/D also had a higher median age (71.8 versus 69.1) and higher rate of urgent admission (47% versus 11.2%), which backs up its use for elderly and sick patients.
A similar surgery to VATS-P/D is pleurodesis. Doctors sew the pleural linings together to eliminate pleural fluid buildup and remove a small percentage of tumors.
The Mount Sinai Medical Center team reported VATS-P/D and talc pleurodesis had similar survival rates, but minimally invasive P/D led to better quality of life. Another study reported a median survival of 14 months for VATS-P/D, which can certainly lengthen the lives of late-stage patients.
“Patients who undergo VATS P/D have better short-term outcomes compared to those who undergo curative attempts at surgery,” Dr. Flores and the other authors wrote. “Therefore, VATS P/D should be considered in the armamentarium of treatment for MPM, especially in older and frailer patients who may not tolerate more radical surgery.”
Sources & Author
- VATS Pleurectomy Decortication Is a Reasonable Alternative for Higher Risk Patients in the Management of Malignant Pleural Mesothelioma: An Analysis of Short-Term Outcomes. MDPI. Retrieved from: https://www.mdpi.com/2072-6694/13/5/1068/htm. Accessed: 04/06/2021.
- Video-Assisted Thorascopic Surgery. Johns Hopkins Medicine. Retrieved from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/video-assisted-thorascopic-surgery. Accessed: 04/07/2021.
Sources & Author