Mesothelioma patients who undergo minimally invasive surgery suffer fewer post-operative complications than those who receive open chest procedures, according to a new study.

Researchers with the Icahn School of Medicine at Mount Sinai in New York found that video-assisted thoracoscopic surgery (VATS) — a form of keyhole surgery — yielded better short-term benefits for mesothelioma patients than more invasive procedures, with fewer overall complications and significantly fewer lung-related issues. The group’s findings appear in the March 3 edition of Cancers.

While surgical resection is considered an “essential component” of mesothelioma care because it significantly improves patient survival time, the optimal surgical approach is a source of ongoing debate, the researchers noted. Invasive surgery is much more common in mesothelioma cases than VATS, which runs contrary to current surgical trends, prompting the team to investigate this “anomaly” and assess the short-term outcomes associated with each type.

Records Search

The researchers combed the files of New York’s Statewide Planning and Research Cooperative System — which collects patient information from hospitals all over the state — and zeroed in on 384 mesothelioma patients that underwent pleurectomy/decortication, a two-part procedure in which the pleural lining is excised and then any visible tumors are removed.

According to the researchers, 269 of those cases were open surgeries, while 115 were VATS. After adjusting the data for confounding variables, the team found that keyhole pleurectomy/decortication leads to fewer overall complications (an odds ratio of 0.37 versus 1.32 for invasive surgery) and significantly fewer pulmonary issues (0.30 versus 1.38).

Based on these findings, the researchers concluded that VATS “remains a viable alternative to radical surgery in [malignant pleural mesothelioma] patients allowing for improved short-term outcomes.” They added that it may also have special benefit to “older and frailer patients who may not tolerate more radical surgery.”

Long-term Benefits Unknown

The study did not compare the long-term survival benefits of these competing surgical techniques, but based on these results, concluded that “further investigation” of VATS’ long-term survival benefits for mesothelioma patients is necessary.

The group’s findings were part of a larger study comparing pleurectomy/decortication — regardless of whether it was invasive or keyhole — to a more radical surgical technique: extrapleural pneumonectomy, which involves the removal of the diseased lung and part of the parietal pleura lining the lung.

That research concluded that extrapleural pneumonectomy patients experienced roughly the same number of post-operative complications (43.5 percent versus 42 percent for pleurectomy/decortication), but suffered significantly more heart-related issues (32.3 percent versus 13.4 percent). This was partially offset by lower rates of lung complications in extrapleural pneumonectomy (21 percent versus 34.2 percent).

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