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

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 an...

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Published inNihon Kokyuki Geka Gakkai zasshi (Kyoto, 1992) Vol. 14; no. 2; pp. 99 - 104
Main Authors Miyata, Michio, Meguro, Hiroaki, Abe, Norifumi, Okada, Shinichiro, Ishida, Hironori, Nagano, Makoto, Kohiyama, Ritsu
Format Journal Article
LanguageEnglish
Published The Japanese Association for Chest Surgery 2000
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ISSN0919-0945
1881-4158
1881-4158
DOI10.2995/jacsurg.14.99

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Abstract 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.
AbstractList 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.
Author Miyata, Michio
Abe, Norifumi
Kohiyama, Ritsu
Ishida, Hironori
Okada, Shinichiro
Nagano, Makoto
Meguro, Hiroaki
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  fullname: Kohiyama, Ritsu
  organization: Department of Respiratory Surgery, Kanto Medical Center NTT EC
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References 8) Sugarbaker DJ, Mentzer SJ, DeCamp M, et al: Extrapleural pneumonectomy in the setting of a multimodality approach to malignant mesothelioma. Chest 103: 377S-381S, 1993.
13) 堀尾裕俊, 野守裕明: びまん性悪性胸膜中皮腫に対する胸膜肺全摘術における開胸法の一工夫. 日呼外会誌 9: 538-541, 1995.
18) 鈴木一也, 高橋毅, 伊藤靖, 他: 自己由来の素材を利用する呼吸器手術. (抄) 日呼外会誌13: 303, 1999.ト
7) 荒井多嘉司, 平田正信, 木村荘一, 他: 悪性びまん性胸膜中皮腫の外科療法― 胸膜肺全別除術の1例を中心に―. 日胸 40: 562-569, 1981.
9) 高木啓吾, 尾形利郎, 増田秀雄, 他: わが国における胸膜中皮腫に対する外科療法. 日胸43: 999-1007, 1984.
2) 高木啓吾: 中皮腫の臨床. 病理と臨床14: 1369-1375, 1996.
16) 村田聖一郎, 小檜山律, 田中真人, 他: 胸骨正中経路で右拡大胸膜肺全摘術と頚部リンパ節郭清を行った右鎖骨上窩リンパ節転移を伴ったびまん性悪性胸膜中皮腫の1例.日胸外会誌42: 404-408, 1994.
11) 佐藤一彦, 前野秀夫, 檀原高, 他: 胸壁, 横隔膜切除を加えた悪性びまん性胸膜中皮腫の1手術例. 日胸47: 444-449, 1988.
6) Rusch VW, Piantadosi S, Holmes EC: The role of extrapleural pneumonectomy in malignant pleural mesothelioma. J Thorac Cardiovasc Surg 102: 1-9, 1991.
14) 桑原正喜, 佐藤寿彦, 岩切章太郎, 他: 悪性胸膜中皮腫に対する胸膜肺全摘術の開胸法の検討. (抄) 日呼外会誌12: 349, 1998.
12) 渋谷潔, 由佐俊和, 伊豫田明, 他: 胸腔鏡下生検にて診断したびまん性胸膜中皮腫の1切除例. 日胸外会誌 45: 1581-1585, 1997.
3) 中野孝司, Chahinian AP, 眞城美穂, 他: 悪性胸膜中皮腫国際TNM分類 (IMIG分類) に関して-従来の病期分類との比較-. 肺癌37: 323-333, 1997.
5) Sugarbaker DJ, Heher EC, Lee TH, et al: Extrapleural pneumonectomy, chemotherapy, and radiotherapy in the treatment of diffuse malignant pleural mesothelioma. J Thorac Cardiovasc Surg 102: 10-15, 1991.
15) 田中浩一, 坪井正博, 池田徳彦, 他: 後側方切開に前方肋骨弓下切開を追加したS字切開による右汎胸膜肺全摘術の経験. (抄) 日呼外会誌13: 300, 1999.
17) 塚田久嗣, 宮元秀昭, 原田龍一, 他: 著明な骨形成を認めたびまん性悪性胸膜中皮腫の1手術例. 日呼外会誌 9: 830-836, 1995.
10) 児玉憲, 土井修, 龍田眞行, 他: 悪性胸膜中皮腫に対する拡大胸膜肺全摘術の経験. 日胸外会誌36: 429-434, 1988.
1) 宮沢直人, 横井香平, 斉藤芳国, 他: 胸膜中皮腫. 日本臨床 51: 696-701, 1993.
4) Butchart EG, Ashcroft T, Barnsley WC, et al: Pleuroneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Thorax 31: 15-23, 1976.
References_xml – reference: 4) Butchart EG, Ashcroft T, Barnsley WC, et al: Pleuroneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Thorax 31: 15-23, 1976.
– reference: 8) Sugarbaker DJ, Mentzer SJ, DeCamp M, et al: Extrapleural pneumonectomy in the setting of a multimodality approach to malignant mesothelioma. Chest 103: 377S-381S, 1993.
– reference: 11) 佐藤一彦, 前野秀夫, 檀原高, 他: 胸壁, 横隔膜切除を加えた悪性びまん性胸膜中皮腫の1手術例. 日胸47: 444-449, 1988.
– reference: 16) 村田聖一郎, 小檜山律, 田中真人, 他: 胸骨正中経路で右拡大胸膜肺全摘術と頚部リンパ節郭清を行った右鎖骨上窩リンパ節転移を伴ったびまん性悪性胸膜中皮腫の1例.日胸外会誌42: 404-408, 1994.
– reference: 12) 渋谷潔, 由佐俊和, 伊豫田明, 他: 胸腔鏡下生検にて診断したびまん性胸膜中皮腫の1切除例. 日胸外会誌 45: 1581-1585, 1997.
– reference: 10) 児玉憲, 土井修, 龍田眞行, 他: 悪性胸膜中皮腫に対する拡大胸膜肺全摘術の経験. 日胸外会誌36: 429-434, 1988.
– reference: 7) 荒井多嘉司, 平田正信, 木村荘一, 他: 悪性びまん性胸膜中皮腫の外科療法― 胸膜肺全別除術の1例を中心に―. 日胸 40: 562-569, 1981.
– reference: 9) 高木啓吾, 尾形利郎, 増田秀雄, 他: わが国における胸膜中皮腫に対する外科療法. 日胸43: 999-1007, 1984.
– reference: 2) 高木啓吾: 中皮腫の臨床. 病理と臨床14: 1369-1375, 1996.
– reference: 14) 桑原正喜, 佐藤寿彦, 岩切章太郎, 他: 悪性胸膜中皮腫に対する胸膜肺全摘術の開胸法の検討. (抄) 日呼外会誌12: 349, 1998.
– reference: 15) 田中浩一, 坪井正博, 池田徳彦, 他: 後側方切開に前方肋骨弓下切開を追加したS字切開による右汎胸膜肺全摘術の経験. (抄) 日呼外会誌13: 300, 1999.
– reference: 3) 中野孝司, Chahinian AP, 眞城美穂, 他: 悪性胸膜中皮腫国際TNM分類 (IMIG分類) に関して-従来の病期分類との比較-. 肺癌37: 323-333, 1997.
– reference: 5) Sugarbaker DJ, Heher EC, Lee TH, et al: Extrapleural pneumonectomy, chemotherapy, and radiotherapy in the treatment of diffuse malignant pleural mesothelioma. J Thorac Cardiovasc Surg 102: 10-15, 1991.
– reference: 1) 宮沢直人, 横井香平, 斉藤芳国, 他: 胸膜中皮腫. 日本臨床 51: 696-701, 1993.
– reference: 17) 塚田久嗣, 宮元秀昭, 原田龍一, 他: 著明な骨形成を認めたびまん性悪性胸膜中皮腫の1手術例. 日呼外会誌 9: 830-836, 1995.
– reference: 18) 鈴木一也, 高橋毅, 伊藤靖, 他: 自己由来の素材を利用する呼吸器手術. (抄) 日呼外会誌13: 303, 1999.ト
– reference: 6) Rusch VW, Piantadosi S, Holmes EC: The role of extrapleural pneumonectomy in malignant pleural mesothelioma. J Thorac Cardiovasc Surg 102: 1-9, 1991.
– reference: 13) 堀尾裕俊, 野守裕明: びまん性悪性胸膜中皮腫に対する胸膜肺全摘術における開胸法の一工夫. 日呼外会誌 9: 538-541, 1995.
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SubjectTerms diffuse malignant mesothelioma
extrapleural pneumonectomy
grand dorsal muscle pedicle flap
subcostal skin incision
Title Rational operative technique of extrapleural pneumonectomy for the treatment of diffuse malignant mesothelioma
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