Bertoglio Pietro, Garelli Elena, Brandolini Jury, Kawamukai Kenji, Antonacci Filippo, Ricciardi Sara, Cipolli Alessandro, Bonfanti Barbara, Forti Parri Sergio Nicola, Daddi Niccolò, Dolci Giampiero, Solli Piergiorgio
Division of Thoracic Surgery, IRCCS Azienda Ospedaliera Universitaria di Bologna, 40138 Bologna, Italy.
J Clin Med. 2021 May 26;10(11):2330. doi: 10.3390/jcm10112330.
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.
间皮瘤是一种起源于壁层胸膜的侵袭性疾病。手术是多模式治疗框架中的一种重要选择。为实现宏观上的完整切除，已规范了多种手术方法；这些方法通常需要同侧膈肌和心包的切除与重建。胸膜外全肺切除术（EPP）和扩大胸膜剥脱术（EPD）已被视为根治性手术。然而，这两种手术在技术上都具有挑战性，且围手术期发病率较高，死亡率也不容忽视。膈肌和心包重建技术对于避免呼吸功能损害以及减少诸如胃和心脏疝等术后并发症至关重要。此外，对于局限性胸壁复发的情况，对于经过严格筛选且身体状况良好的患者，手术可能是一种有价值的治疗选择。本文描述了膈肌、心包和胸壁切除与重建的所有技术细节，以及新的微创技术的可能应用。此外，还讨论了考虑到该领域最新创新的不同假体材料的选择。
