Mesothelioma Treatments

Mesothelioma Surgery - Thoracoscopy

Thoracoscopy is an alternative to the more invasive procedure called thoracotomy. Thoracoscopy is a medical procedure in which doctors insert a very long, thin tube into the body between two ribs. This tube has mirrors or a small camera attached to it so that with only a small incision and no invasive surgery, doctors can see the internal organs and collect cells for diagnostic biopsy. The procedure can also be used to introduce medications or other treatments directly into the lungs, to treat pleural effusion which is accumulated fluid around the lungs, remove empyema - pus associated with previous treatments, or to remove blood in the space around the lungs.

Research on Thoracoscopy Procedure

Research, both within the United States and abroad has shown that thoracoscopy is a vital tool in diagnosing pleural cancers. Between 1973 and 1990, diagnostic thoracoscopy was carried out in a prospective series of 188 patients with malignant pleural mesothelioma (MPM). Biopsy samples were obtained in all cases, and the French panel of mesothelioma specialists confirmed diagnosis.

In all patients the doctors were able to use this procedure to identify the degree of involvement of the parietal, diaphragmatic, or visceral pleura. In conjunction with the biopsy results, they were also able to classify the stage of cancer in each of the patients. Another study in China at about the same time confirmed that diagnosis was possible using thoracoscopy as opposed to a more invasive technique in almost 95 percent of the cases studied.

More recently, a study of 95 patients was done in the United States in 2007. Of these 95 patients, 75 underwent extra pleural pneumonectomy, and 20 patients underwent pleurectomy. Among the 87 patients classified as having MPM of epithelial subtype after the initial thoracoscopy, 75 cases (86.2 percent) were confirmed to be a true histological diagnosis and 12 cases (13.8 percent) were found to be of biphasic subtype at final diagnosis following open surgery treatment.

The sensitivity and specificity values of an epithelial subtype diagnosis after thoracoscopy were 94 percent and 20 percent, respectively, with a positive predictive value of 86 percent and a negative predictive value of 37 percent. Conversely, the sensitivity and specificity values of a biphasic subtype diagnosis after thoracoscopy were 20 percent and 98 percent, respectively, with a positive predictive value of 75 percent and a negative predictive value of 87 percent.

Moving beyond the numbers, what all this means is that not only can thoracoscopy diagnose the presence and extent of mesothelioma; it can also predict with high accuracy the type of mesothelioma the patient has. For more information on the thoracoscopy procedure and other treatment options, please fill out the form on this page to receive a free comprehensive informative packet.

The Procedure

Usually thoracoscopy is performed under general anesthesia, but some hospitals and doctors are beginning to use local anesthesia. In mesothelioma cases, thoracoscopy is used to examine the lungs, the lining of the lungs, and the areas immediately adjacent to the lungs. This type of thoracoscopy is called pleuroscopy, since it is focused on the pleural tissue.

During a thoracoscopy, the patient is placed on a respirator, and the diseased lung is partially deflated to create enough space for the camera to maneuver. The doctor makes an incision in the chest between the ribs so the tube can be inserted. The camera allows the doctor to explore the area. Samples of cells are removed, medication is applied, and excess fluid and empyema can be removed.

Recovery and Risks

After the procedure a drainage tube is placed in the chest to allow for the drainage of fluid. The lungs are gradually allowed to resume function, and the patient is removed from the respirator.

Few risks are associated with thoracoscopy, and it is substantially less risky than a full open surgery. Historically there were some concerns about "tumor seeding" that is, spreading the tumor by pulling cancerous cells into non-cancerous areas through the movement of the camera.

This fear was demonstrated to be unfounded when the procedure was combined with preventive radiotherapy. A study done in 1995 showed that in 20 of 20 patients, who had a combined total of 38 thoracoscopy procedures, none developed tumors related to the procedure. More realistic risks include difficulty in getting the lungs to fully re-inflate and resume function. There are also the risks associated with any use of anesthesia as well as the potential for infection either at the incision site, or internally.

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