Abstract
We performed extrapleural pneumonectomy (EPP) with combined resection of the diaphragm and pericardium via a lower door open (LDO) thoracotomy to treat right malignant pleural mesothelioma (MPM) in a 57-year-old man. Specifically, we extended the standard posterolateral thoracotomy skin incision along the anterior costal arch, and performed the thoracotomy by cutting into the 6th to 9th costal cartilage. The resulting defect of the diaphragm and pericardium were reconstructed with a reversed latissimus dorsi (LD) muscle flap and a fascia lata graft, respectively. The patient had an uneventful postoperative course without dyspnea or dysfunction of the extremities. The LDO thoracotomy provided a good operative field, especially for the costo- and cardiophrenic angles, allowing a complete resection of the diaphragm to be performed easily. Furthermore, the reversed LD muscle flap and fascia lata graft proved to be ideal autologous materials for reconstruction of both the diaphragm and the pericardium.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
EG Butchart T Aschcroft WC Barnsley MP Holden (1976) ArticleTitlePleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients Thorax 31 IssueID1 15–24 Occurrence Handle1257933 Occurrence Handle1:STN:280:DyaE287lsVOgtw%3D%3D Occurrence Handle10.1136/thx.31.1.15
VW Rusch ES Venkatraman (1996) ArticleTitleThe importance of surgical staging in the treatment of malignant pleural mesothelioma J Thorac Cardiovasc Surg 111 815–26 Occurrence Handle8614142 Occurrence Handle1:STN:280:DyaK287osVemtw%3D%3D Occurrence Handle10.1016/S0022-5223(96)70342-2
DJ Stewart AE Martin-Ucar JG Edwards K West DA Waller (2005) ArticleTitleExtra-pleural pneumonectomy for malignant pleural mesothelioma: the risks of induction chemotherapy, right-sided procedures and prolonged operations Eur J Cardiothorac Surg 27 373–8 Occurrence Handle15740941 Occurrence Handle10.1016/j.ejcts.2004.12.028
DJ Sugarbaker MT Jaklitsch R Bueno W Richards J Lukanich SJ Mentzer et al. (2004) ArticleTitlePrevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies J Thorac Cardiovasc Surg 128 138–46 Occurrence Handle15224033 Occurrence Handle10.1016/j.jtcvs.2004.02.021
DJ Sugarbaker SJ Mentzer G Strauss (1992) ArticleTitleExtra-pleural pneumonectomy in the treatment of malignant pleural mesothelioma Ann Thorac Surg 54 941–6 Occurrence Handle1417290 Occurrence Handle1:STN:280:DyaK3s%2Fjslymsw%3D%3D Occurrence Handle10.1016/0003-4975(92)90654-M
AV Bedini S Adreani G Muscolino (2000) ArticleTitleLatissimus dorsi reverse flap to substitute the diaphragm after extrapleural pneumonectomy Ann Thorac Surg 69 986–8 Occurrence Handle10800779 Occurrence Handle1:STN:280:DC%2BD3c3lvVOitQ%3D%3D Occurrence Handle10.1016/S0003-4975(99)01555-6
AE Martin-Ucar DJ Stewart KJ West DA Waller (2005) ArticleTitleA median sternotomy approach to right extrapleural pneumonectomy for mesothelioma Ann Thorac Surg 80 1143–5 Occurrence Handle16122519 Occurrence Handle10.1016/j.athoracsur.2004.04.038
H Horio H Nomori (1995) ArticleTitleThoracotomy technique for extrapleural pneumonectomy in treatment of diffuse pleural mesothelioma J Jap Assoc Chest Surg 9 538–41 Occurrence Handle10.2995/jacsurg.9.538
CA Wallace JS Roden (1995) ArticleTitleReverse, innervated latissimus dorsi flap reconstruction of congenital diaphragmatic absence Plast Reconstr Surg 96 761–9 Occurrence Handle7652049 Occurrence Handle1:STN:280:DyaK2MzotVGisQ%3D%3D
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Yoshioka, M., Nomori, H., Mori, T. et al. Extrapleural Pneumonectomy via a Lower Door Open Thoracotomy with Reconstruction of the Diaphragm and Pericardium Using Autologous Materials for Mesothelioma. Surg Today 36, 1036–1038 (2006). https://doi.org/10.1007/s00595-006-3297-3
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00595-006-3297-3