Laparoscopy: An important tool in the staging of malignant pleural mesothelioma

Background: The current standard for the noninvasive staging of patients with malignant pleural mesothelioma is computed tomography (CT). However, CT often cannot determine whether a tumor is unresectable because of direct extension through the diaphragm to the peritoneal cavity. The aim of this prospective study was to determine whether laparoscopy detected transdiaphragmatic tumor extension when CT findings were equivocal. Methods: From June 1993 to July 1994, 12 of 36 patients considered for possible thoracotomy and surgical resection had equivocal CT findings of diaphragmatic invasion. All underwent laparoscopy using a multiport technique with diaphragmatic and peritoneal biopsies. Results: The mean operative time was 83 min. There were no perioperative complications. The median hospital stay was 1 day. Six patients had biopsy-proven transdiaphragmatic extension, or peritoneal studding of tumor. The other six patients subsequently underwent thoracotomy: three had a complete resection, and three had unresectable tumor due to chest wall (N=2) or mediastinal (N=1) invasion. In no case was transdiaphragmatic extension of a tumor seen. Conclusions: This preliminary experience demonstrates that laparoscopy is a safe and accurate method for detecting transdiaphragmatic tumor extension when CT fails to do so. Laparoscopy should be considered a standard part of prethoracotomy staging in this subset of patients. Results of this study were presented at the 48th Annual Cancer Symposium of The Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.