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Review
. 2021 May 26;10(11):2330.
doi: 10.3390/jcm10112330.

Surgical Management and Reconstruction of Diaphragm, Pericardium and Chest Wall in Mesothelioma Surgery: A Review

Pietro Bertoglio  1 , Elena Garelli  1 , Jury Brandolini  1 , Kenji Kawamukai  1 , Filippo Antonacci  1 , Sara Ricciardi  1 , Alessandro Cipolli  1 , Barbara Bonfanti  1 , Sergio Nicola Forti Parri  1 , Niccolò Daddi  1 , Giampiero Dolci  1 , Piergiorgio Solli  1
Affiliations
Review

Surgical Management and Reconstruction of Diaphragm, Pericardium and Chest Wall in Mesothelioma Surgery: A Review

Pietro Bertoglio et al. J Clin Med. .

Abstract

Mesothelioma is an aggressive disease arising from parietal pleura. Surgery is a valuable option in the frame of a multimodality treatment. Several surgical approaches have been standardized with the aim of a macroscopic complete resection; these often require homolateral diaphragm and pericardial resection and reconstruction. Extrapleural pneumonectomy (EPP) and extended pleurectomy decortication (EPD) have been recognized as radical surgical procedures. Nevertheless, both operations are technically challenging and associated with a significant rate of peri-operative morbidity and non-negligible mortality. The diaphragmatic and pericardial reconstruction technique is mandatory to avoid respiratory impairment and to reduce post-operative complications like gastric and cardiac herniation. Moreover, in the case of localized chest wall recurrence, surgery might be considered a valuable therapeutical option for highly selected and fit patients. All the technical aspects of the resection and reconstruction of the diaphragm, pericardium, and chest wall are described as well as the possible use of new minimally invasive techniques. In addition, the choice of different prosthetic materials, considering the most recent innovations in the field, are discussed.

Keywords: chest wall; diaphragm; malignant pleural mesothelioma; pericardium; surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The diaphragmatic rim left in place for suturing diaphragmatic patch (credits: Solli, P.; Brandolini, J.; Pardolesi, A.; Nardini, M.; Lacava, N.; Parri, S.F.; Kawamukai, K.; Bonfanti, B.; Bertolaccini, L. Diaphragmatic and pericardial reconstruction after surgery for malignant pleural mesothelioma. J. Thorac. Dis. 2018, 10, S298–S303.).
Figure 2
Figure 2
Anchoring of diaphragmatic patch (credits: Solli, P.; Brandolini, J.; Pardolesi, A.; Nardini, M.; Lacava, N.; Parri, S.F.; Kawamukai, K.; Bonfanti, B.; Bertolaccini, L. Diaphragmatic and pericardial reconstruction after surgery for malignant pleural mesothelioma. J. Thorac. Dis. 2018, 10, S298–S303.).
Figure 3
Figure 3
An L-shaped titanium plate used to fix the diaphragmatic patch as described by Schiavon et al. (credits: Solli, P.; Brandolini, J.; Pardolesi, A.; Nardini, M.; Lacava, N.; Parri, S.F.; Kawamukai, K.; Bonfanti, B.; Bertolaccini, L. Diaphragmatic and pericardial reconstruction after surgery for malignant pleural mesothelioma. J. Thorac. Dis. 2018, 10, S298–S303.).
See this image and copyright information in PMC

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