Kyobu Geka. 2007 Jan;60(1):45-8. [Link]

Sato Y, Endo S, Tezuka Y, Kanai Y, Otani S, Yamamoto S, Teduka K, Hasegawa T, Sobara Y.

Division of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Japan.


Malignant pleural mesothelioma is an aggressive neoplasm with poor prognosis. Extrapleural pneumonectomy is performed as surgical therapy. It is difficult to obtain enough range of view at costophrenic angle. We adopt extrapleural pneumonectomy with wide resection of the chest wall, diaphragm, and pericardium to remove the main lesion at the costophrenic angle and report 6 cases received this surgical procedure. With this procedure, a wide view of costophrenic angle and costal-pericardial angle can be obtained, and the resection margin can be placed outside the chest wall, costophrenic angle and costal-pericardial angle, which enables complete resection of masses at the costophrenic and costal-pericardial angles. Furthermore, extrapleural pneumonectomy with wide resection of the chest wall minimizes the resulting dead space, thereby minimizing the risk of postoperative hemorrhage and empyema. We consider that this procedure can be applied for malignant mesothelioma patients, especially those who have pleural masses at costophrenic angle.