Khirurgiia (Sofiia). 2007;62(4):23-6. [Link]

Mourdjev K, Ouchikov A, Yankulov A, Paskalev G.

Clinic of Thoracic Surgery, University Hospital "St. George" – Plovdiv.


Introduction. Mesothelioma is characterized by aggressive follow-up, difficult diagnosis and treatment fatal issue. In one side the restricted possibility for operative treatment and the other side the resistance of tumors for chemotherapy are the mean reasons for bad results in patients with malignant pleural mesothelioma. We have aim to make a retrospective study of patients with malignant pleural mesothelioma in 3-th and 4-th stage, undergoing operation in our clinic and see VATS effectiveness.

Patients and methods: In the clinic of thoracic surgery in University Hospital "St.George" – Plovdiv we made retrospective study in 21 patients undergoing operation in the occasion of advanced pleural mesothelioma. It was thoroughly men (14) in age between 45-72 years (58.6). In 18 (85%) patients the disease was proven intraoperative or on the final histological result after operation. Before operation in this patients in help of diagnosis, we have information by image examination (radiography, CT of thorax and if it necessary to mark pleural effusion – sonography of pleural cavity ) abdominal sonohography or CT of abdomen for exclusion of distant metastasis, fibrobronchoscopy (FBS) for confirmation or exclusion of endobronchial cancer and transthoracic aspiration biopsy (TTAB).

Results: We describe improvement in the most of patients. In 2 patients we have not improvement. In this situation we made Bulao drainage. Death issue in early postoperative period we have in 1 patient with increased breath insufficiency despite evacuation of pleural effusion and unfolded lung.

Discussion: Early diagnosis of malignant pleural mesothelioma is difficult, in some times impossible. After histological verification the diagnosis is proven. Image examination is still insufficient. The difficulty comes by insufficient cytologic and histologic verification before operation and also insufficiency of image examination. Because of the chemotherapy is insufficient, surgical treatment (radical or not) in huge number of cases help improvment of patient’s condition.

Conclusion: 1.Surgical treatment is decisive for diagnosis and treatment of malignant pleural mesothelioma even in advanced cases and have evident positive effects. 2. Surgical methods improve patient’s condition, even in inoperable cases. 3. VATS surgery is modern method for diagnosis and treatment and if it necessary we can continue by conventional operation for definitive treatment of mesothelioma.