Diode-Pumped Laser for Lung-Sparing Surgical Treatment of Malignant Pleural Mesothelioma

Our plain-English summary of Diode-Pumped Laser for Lung-Sparing Surgical Treatment of Malignant Pleural Mesothelioma, by S. Bölükbas, C. Biancosino, B. Redwan, et al (The Annals of Thoracic Surgery, 2017).

The study

• Authors: S. Bölükbas, C. Biancosino, B. Redwan, M. Eberlein
• Journal: The Annals of Thoracic Surgery
• Published: 2017;103(6):e529-e530
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Surgical resection represents one of the essential cornerstones in multimodal treatment of malignant pleural mesothelioma. In cases of tumor infiltration of the lung, lung-scarifying procedures such as lobectomies or pneumonectomies might be necessary to achieve macroscopic complete resection. However, this increases the morbidity of the patients because it leads to possible delay of the planned chemotherapy or radiotherapy. Innovative surgical techniques are therefore required to enable salvage of the lung parenchyma and optimization of surgical treatment. Here we report our first experience with a diode-pumped neodymium-doped yttrium aluminium garnet laser for parenchyma-sparing lung resection during surgery for malignant pleural mesothelioma.

Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This case report described one patient operated on at a thoracic surgery department in Wuppertal, Germany. The patient, aged 53, had biopsy-proven epitheloid malignant pleural mesothelioma at clinical IMIG stage II. The article does not mention asbestos exposure. During a radical pleurectomy through the right side of the chest, the surgeons found tumor growing into the lower (basilar) segments of the lung. Instead of removing a lobe or a whole lung, they used a diode-pumped Nd:YAG laser (1318 nm, 100 watts) to cut out the affected lung tissue. All visible tumor was removed. The operation took 4 hours 47 minutes, blood loss was about 450 mL, and no complication occurred during surgery. Recovery was uneventful, and the patient was discharged on day 13. Pathology showed complete tumor resection. The stage after surgery was IV (pT4 pN0 (0/17)) because tumor had also reached chest wall soft tissue. The patient completed chest wall radiation and chemotherapy without delay and had no evidence of disease 18 months after surgery. The authors concluded that, in this first experience, the laser contributed to safe surgery, and that further studies are needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 53-year-old patient with biopsy-proven epitheloid malignant pleural mesothelioma, clinical IMIG stage II, treated at the authors' institution (Department of Thoracic Surgery, Helios University Hospital Wuppertal, Germany). Dates of treatment are not given.
• Exposure: No asbestos exposure is reported. The article concerns a surgical tool: a diode-pumped neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, LIMAX 120, wavelength 1318 nm, used at 100 watts to cut through lung tissue during radical pleurectomy.
• Main results:
  • Tumor had grown into the basilar lung segments. The affected segments were removed with the laser instead of procedures that remove lung, and macroscopic complete resection was achieved.
  • For this patient, operative time was 4 hours 47 minutes, intraoperative blood loss was approximately 450 mL, and no intraoperative complication occurred.
  • The postoperative course was uneventful, and the patient was discharged on postoperative day 13.
  • Pathology showed complete tumor resection. The postoperative stage was IMIG IV, pT4 pN0 (0/17), because tumor had also infiltrated chest wall soft tissue (two foci) as well as the basilar lung segments.
  • The patient completed adjuvant chest wall radiation and chemotherapy without delay and had no evidence of disease 18 months after surgery.
• The authors' conclusion: The authors concluded that in this first experience the laser contributed to safe performance of surgery. They wrote that they believe it 'might represent an important surgical tool' in treating malignant pleural mesothelioma, but that further experimental and clinical studies are needed.
• Limitations the authors state:
  • The authors stated that further experimental investigation and clinical studies are needed.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Surgical Resection, Chemotherapy, Parenchyma.

Related studies

• Photodynamic therapy and the evolution of a lung-sparing surgical treatment for mesothelioma — J.S. Friedberg, R. Mick, et al. (2011)
• Lung-sparing total pleurectomy: the surgical option of choice in malignant pleural mesothelioma? — D.A. Waller (2013)
• Elemental Mapping of Human Malignant Mesothelioma Tissue Samples Using High-Speed LA-ICP-TOFMS Imaging — O.M. Voloaca, M.R. Clench, et al. (2022)
• Prospective study on functional results after lung-sparing radical pleurectomy in the management of malignant pleural mesothelioma — S. Bölükbas, M. Eberlein, et al. (2012)
• Factors predicting poor survival after lung-sparing radical pleurectomy of IMIG stage III malignant pleural mesothelioma — S. Bölükbas, M. Eberlein, et al. (2013)
• A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma — C. Cao, D. Tian, et al. (2014)

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