Technique of Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma

Valerie W. Rusch, M.D

Key Points

  • Preoperative evaluation includes computed tomographic (CT) scanning of the chest and upper abdomen, positron emission tomography (PET)-CT scanning, pulmonary function tests, quantitative ventilation/perfusion scanning and cardiac evaluation.
  • Thoracotomy is performed via an extended S-shaped posterolateral incision with resection of the sixth rib.
  • The pleural tumor is mobilized away from the chest wall and mediastinum with careful attention to hemostasis.
  • The diaphragm is partially or completely resected. Depending on the extent of the tumor, pericardial resection may or may not be required.
  • After subcarinal node dissection, the main stem bronchus then the hilar vessels are ligated or divided.
  • The diaphragmatic reconstruction should be placed at the same level as the native diaphragm. Pericardial defects should also be reconstructed.
  • Postoperative care should emphasize meticulous pulmonary toilet and fluid management with transfusion as required and prophylaxis of supraventricular arrhythmias.

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Last updated: January 3, 2020