Surgery for malignant pleural mesothelioma

Figures & data

Figure 1. Extrapleural pneumonectomy: chest retractors are placed to increase the initial exposure of the tumor.

Reprinted with permission from [69].

Figure 2. Extrapleural pneumonectomy: a nasogastric tube is inserted in the esophagus to prevent injury while the tumor is being resected off the esophagus.

Reprinted with permission from [69].

Figure 3. Extrapleural pneumonectomy: the diaphragm is avulsed or bluntly separated from the chest wall muscular attachments.

Reprinted with permission from [69].

Figure 4. Pleurectomy/decortication: visceral pleurectomy (decortication) is accomplished in two stages.

First, the tumor is incised posteriorly to the hilum and a plane is developed between the visceral pleura and the underlying lung parenchyma.

Reprinted with permission from [70].

Figure 5. Pleurectomy/decortication: the fully decorticated lung is retracted out of the lower tumor shell.

The tumor shell is then resected and removed from the operative field.

Reprinted with permission from [70].

Figure 6. Pleurectomy/decortication: appearance of the decorticated lung after the visceral and parietal pleurae have been resected (with diaphragm intact).

To achieve macroscopic complete resection for a tumor that invades the diaphragm, a split-thickness, partial or complete hemi-diaphragmatic resection may be required. In the case of partial resection, primary repair or autologous reconstruction may be possible, but in the case of complete resection, a patch is created similar to the technique of extrapleural pneumonectomy, which has previously been described [17].

Figure 103.2. In: Adult Chest Surgery (First Edition). The McGraw-Hill Companies, NY, USA (2009).

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Wolf AS, Daniel J, Sugarbaker DJ. Surgical techniques for multimodality treatment of malignant pleural mesothelioma: extrapleural pneumonectomy and pleurectomy/decortication. Semin. Thorac Cardiovasc. Surg.21(2), 132–148 (2009).

 PubMedGoogle Scholar

Wolf AS, Daniel J, Sugarbaker DJ. Surgical techniques for multimodality treatment of malignant pleural mesothelioma: extrapleural pneumonectomy and pleurectomy/decortication. Semin. Thorac. Cardiovasc. Surg.21(2), 132–148 (2009).

 PubMedGoogle Scholar