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The Patient Journey

Surgical Procedures

Video-assisted thoracoscopic surgery (VATS) with talc pleurodesis

VATS is a minimally invasive thoracic surgery performed with a videoscope inserted into the pleural space. The pleural effusion is drained, allowing the lung to re-expand. Sterile talcum powder is injected into the pleural space which causes inflammation between the visceral pleura and parietal pleura causing them to fuse together (pleurodesis). Usually, a biopsy is collected for analysis and diagnosis.1,2

Thoracotomy with parietal pleurectomy and pulmonary decortication

A posterior thoracotomy is initiated when VATS does not achieve a pleurodesis or for further debulking of tumours that encase the lung (pulmonary decortication) to permit re-expansion of the lung. A parietal pleurectomy is completed where the tumour affected pleura is removed from the chest wall.1,2

Images: Cao, C. D’amico, D. Demmy, T. Dunning, J et al. (2016). Comparative incisions for VATs and open thoracotomy in the treatment of non-small-cell lung cancer. [Online Image]. Less is more: a shift in the surgical approach to non-small lung cancer. 2016;4(3).

Indwelling Pleural Catheter (IPC)

When drainage of the pleural effusion via thoracoscopy and thoracotomy will not achieve an optimal clinical outcome or the patient is not an appropriate candidate for surgery, then insertion of an IPC may be considered for the management of a recurrent malignant pleural effusion. The drainage system is designed for intermittent drainage so that the patient can manage the fluid and the symptom of breathlessness at home with community nursing support or by themselves.1

Image: Pangrace, J. (2016). Draining of a Pleural Effusion in the Left Hemithorax. [Online Image]. When should an indwelling pleural catheter be considered for malignant pleural effusion?;83(12) 891-894. https://www.ccjm.org/content/83/12/891

References

  1. McLean J, McCaughan BC. Diagnosis and treatment: the journey of a patient with malignant pleural mesothelioma. Sydney: The Baird Institute; 2013.
  2. Mothoneos J, editor. Understanding Mesothelioma. A guide for people with cancer, their families and friends.: Cancer Council Australia; 2019.