Thoracic shaping technique to avoid residual space after extended pleurectomy/decortication

Our plain-English summary of Thoracic shaping technique to avoid residual space after extended pleurectomy/decortication, by S. Bölükbas, M. Eberlein, J. Schirren (European Journal of Cardio-thoracic Surgery, 2013).

The study

• Authors: S. Bölükbas, M. Eberlein, J. Schirren
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2013;44(3):563-4
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Extended pleurectomy/decortication or radical pleurectomy is defined as a lung-sparing surgical procedure for malignant pleural mesothelioma. A significant size mismatch between the thoracic cavity and the reduced size of the remaining lung might occur as a result of multiple resections at different sites and lead to residual thoracic space. Residual thoracic space and significant air leakage might result in postoperative complications. A simple technique of diaphragm reconstruction to avoid the residual thoracic space and to reduce the incidence of postoperative complications is described.

In plain English

This article described a surgical technique, illustrated with one patient's case. The patient was a 71-year-old man with previous occupational asbestos exposure and a left-sided pleural effusion. A biopsy confirmed epitheloid malignant pleural mesothelioma. He underwent radical pleurectomy, a lung-sparing operation. Because the tumour had infiltrated the diaphragm and deep into the lung, the whole diaphragm was removed and multiple wedges of lung were cut out. This left the remaining lung much smaller than the chest cavity. The surgeons rebuilt the diaphragm with a 2 mm Goretex patch placed three intercostal (rib) spaces above its original level. He was extubated (taken off the breathing tube) immediately after surgery, and a chest X-ray showed full expansion of the left lung. The authors reported using the technique with good success in 7 patients, all with an uneventful postoperative course. They wrote that air leakage, chest tube duration and hospital stay seemed shorter, but gave no figures. In one right-sided case, fluid collected under the patch and was later reabsorbed. The authors concluded the technique might avoid residual thoracic space and reduce complications.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: surgical technique description with a single case report, plus a brief mention of use in 7 patients
• Who was studied: one 71-year-old man with a left-sided pleural effusion and epitheloid malignant pleural mesothelioma, treated in Wiesbaden, Germany. The authors also mention 7 patients treated with the technique to date.
• Exposure: previous occupational asbestos exposure. No fiber type, job or dose is given.
• Main results:
  • Video-thoracoscopic pleural biopsy confirmed epitheloid malignant pleural mesothelioma in the patient
  • Because of infiltration found during surgery, the patient's diaphragm was completely removed
  • The diaphragm was reconstructed three intercostal spaces above its previous level, using a 2 mm Goretex patch
  • The patient was extubated immediately after surgery, and the postoperative chest X-ray showed full expansion of the left lung
  • Pathology of the removed tissue confirmed IMIG Stage III, pT2 pN2 (2 of 27)
  • The authors reported performing the technique with good success in 7 patients to date
  • In one right-sided case, the space between the Goretex patch and the remaining diaphragm or peritoneum filled with fluid early on, and the fluid was reabsorbed later
  • All patients had an uneventful postoperative course. There seemed to be shorter air leakage, chest tube duration and length of hospital stay, with no numbers or comparison group given.
• The authors' conclusion: The authors concluded that this simple and safe technique of diaphragm reconstruction might avoid residual thoracic space and reduce the incidence of postoperative complications.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleurectomy/Decortication (P/D), Pleural Mesothelioma, Diaphragm.

Related studies

• Non-incisional pleurectomy-decortication for malignant pleural mesothelioma — F. Tanaka, N. Imanishi, et al. (2018)
• Extended pleurectomy decortication for thymoma with pleural dissemination — N. Imanishi, Y. Nabe, et al. (2019)
• A Clinical Trial of TumorGlow to Identify Residual Disease During Pleurectomy and Decortication — J.D. Predina, A.D. Newton, et al. (2019)
• Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma — S. Hasegawa (2014)
• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)
• Effects of extended pleurectomy and decortication on quality of life and pulmonary function in patients with malignant pleural mesothelioma — D. Burkholder, D. Hadi, et al. (2015)

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