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Extended posterolateral–subcostal thoracotomy for extrapleural pneumonectomy: a surgical approach for radical operation of pleural mesothelioma

Second Department of Surgery, Kagawa Medical University, 1750-1, Miki-cho, Kita-gun, Kagawa 761-0793, Japan

^* Corresponding author. Tel.: +81-87-891-2191; fax: +81-87-891-2192
yokomise{at}kms.ac.jp

Extrapleural pneumonectomy is an essential procedure in multimodality therapy of malignant pleural mesothelioma. However, radical resection may be difficult in a standard posterolateral thoracotomy because the edge of the diaphragm is located in the dead angle of the pleural cavity. We have tried a subcostal thoracotomy following a posterolateral thoracotomy (extended posterolateral–subcostal thoracotomy) for extrapleural pneumonectomy. With extended posterolateral–subcostal thoracotomy, ideal surgical resection, with en bloc removal of the lung, parietal pleura, pericardium and diaphragm, can be performed radically, but safely, without a second thoracotomy. We conclude that extended posterolateral–subcostal thoracotomy is an effective approach for extrapleural pneumonectomy.

Key Words: Thoracotomy; Pleural cavity; Mesothelioma; Pleural disease; Diaphragm