Extrapleural Pneumonectomy via a Lower Door Open Thoracotomy with Reconstruction of the Diaphragm and Pericardium Using Autologous Materials for Mesothelioma

Surgery Today. 2006;36(11):1036-8. [Link]

Masakazu Yoshioka1, Hiroaki Nomori1, Takeshi Mori1, Hironori Kobayashi1, Kazunori Iwatani1, Koei Ikeda1 and Kentaro Yoshimoto1

(1) Department of Thoracic Surgery, Graduate School of Medicine, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
(2) Department of Respiratory Medicine, Saiseikai Kumamoto Hospital, Chikami 5-3-1, Kumamoto 861-4193, Japan

Received: 04 March 2006 Accepted: 11 April 2006


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.

Keywords: Mesothelioma, Extrapleural pneumonectomy, Latissimus dorsi muscle