title: Extrapleural pneumonectomy via a lower door open thoracotomy with reconstruction of the diaphragm and pericardium using autologous materials for mesothelioma.
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.
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yoshioka
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nomori
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mori
authors.forename: Hironori
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Kazunori
authors.initials: K
authors.lastname: Iwatani
authors.forename: Koei
authors.initials: K
authors.lastname: Ikeda
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshimoto
mesh_terms: D003964:Diaphragm / Q000601:surgery*; D005206:Fascia Lata / Q000637:transplantation; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D009367:Neoplasm Staging; D010496:Pericardium / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods*; D013524:Surgical Flaps; D013908:Thoracotomy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous