Rational operative technique of extrapleural pneumonectomy for the treatment of diffuse malignant mesothelioma.

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We experienced four cases of diffuse malignant mesothelioma in 1998. These four patients underwent extrapleural pneumonectomy. In order to perform safe and rational resection, we devised two points of operative technique. First, the modified postero-lateral incisional line was prolonged along the anterior costal arch and by transecting the costal arch at the point of 6thand 7thcostal cartilages, a wide and clear operative field was gained. Especially diaphragm was resected easily and completely through the good operative field. Second, the grand dorsal muscle pedicle flap was sewn onto the place where the pericardium and right hemi-diaphragm were removed. The benefit of using the grand dorsal muscle pedicle flap is not only to avoid prosthesis but to cover easily the bronchial stump or unexpectedly injured organ such as esophageal adventitia. Results of this rational extrapleural pneumonectomy were as follows ; the average operation time was 6 hs. 25 min., the average volume of bleeding was 1, 260 ml. These results show that our method is safe and less invasive compared with conventional extrapleural pneumonectomy via postero-lateral approach. We are going to add further improvement of this method and expand the indication of operation on diffuse malignant mesothelioma.
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