Diaphragm reconstruction by GORE DUALMESH in patients undergoing resection for thoracic malignancies

Our plain-English summary of Diaphragm reconstruction by GORE DUALMESH in patients undergoing resection for thoracic malignancies, by A. Sano, Y. Azuma, T. Sakai, et al (Journal of Cardiothoracic Surgery, 2021).

The study

• Authors: A. Sano, Y. Azuma, T. Sakai, S. Koezuka, H. Otsuka, A. Iyoda
• Journal: Journal of Cardiothoracic Surgery
• Published: 2021;16(1):65
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: We used GORE DUALMESH for the reconstruction of diaphragms in patients with thoracic malignancies. Here, we report the results.

Methods: Between July 2015 and August 2017, diaphragm reconstruction using 2-mm GORE DUALMESH was performed in 7 patients undergoing surgical resection for thoracic malignancies. After resection of the diaphragm, the mesh was trimmed to the size of defect and placed with the smooth surface facing the chest cavity and the rough surface facing the abdomen. It was fixed with interrupted sutures consisting of synthetic monofilament nonabsorbable 1-0 to 2 threads.

Results: Indications for resection were malignant pleural mesothelioma and primary lung cancer in 5 and 2 patients, respectively. Patients with malignant pleural mesothelioma underwent pleurectomy with decortication; patients with primary lung cancer underwent lung lobectomy. Right and left diaphragm reconstruction was performed for 4 and 3 patients, respectively. Neither complications related to diaphragm reconstruction nor displacement of mesh occurred during a follow-up period ranging from 11 days to 37 months.

Conclusions: GORE DUALMESH is a good synthetic material for diaphragm reconstruction, because its smooth surface prevents adhesions to the lung and its rough surface allows adherence to abdominal tissue.

In plain English

This was a retrospective review of the medical records of 7 patients (6 men and 1 woman, mean age 70 years). Between July 2015 and August 2017, each had part or all of the diaphragm removed and rebuilt with a 2-mm synthetic mesh called GORE DUALMESH. The mesh has a smooth surface, which was placed facing the chest cavity, and a rough surface, which was placed facing the abdomen. Five patients had malignant pleural mesothelioma and underwent pleurectomy with decortication. Two had primary lung cancer and underwent lung lobectomy, and one of these also had part of the liver removed. The right diaphragm was rebuilt in 4 patients and the left in 3. Follow-up lasted from 11 days to 37 months. During that time no complications related to the reconstruction occurred, and the mesh did not move out of place in any patient. The authors concluded that GORE DUALMESH is a good synthetic material for diaphragm reconstruction. They named as limitations the small number of cases, the short follow-up, the retrospective design and the lack of comparison with other materials. The article does not discuss asbestos exposure.

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: Retrospective observational case series (review of medical records)
• Who was studied: 7 patients (6 males, 1 female; mean age 70 years, range 62 to 77) who had diaphragm reconstruction with GORE DUALMESH during surgery for thoracic malignancies, July 2015 to August 2017
• Exposure: No asbestos exposure was studied. The intervention was 2-mm GORE DUALMESH, trimmed to fit the defect left by diaphragm resection, with the smooth surface facing the chest cavity and the rough surface facing the abdomen
• Main results:
  • Diaphragm resection was done for malignant pleural mesothelioma in 5 patients and for primary lung cancer in 2 patients
  • The 5 patients with malignant pleural mesothelioma underwent pleurectomy with decortication. The 2 patients with primary lung cancer underwent lung lobectomy.
  • One of the 2 primary lung cancer patients also underwent liver resection
  • The right diaphragm was reconstructed in 4 patients and the left in 3
  • Across all 7 patients, no complications related to diaphragm reconstruction and no displacement of mesh occurred during follow-up of 11 days to 37 months
  • Three-dimensional CT renderings were available for 2 patients (cases 2 and 3). In case 2 the mesh was shaped to accommodate the spleen without distortion, and in case 3 the liver.
  • In the 2 lung cancer patients, whose diaphragm resection opened the peritoneum, symptoms due to peritoneal adhesion did not occur
• The authors' conclusion: The authors concluded that GORE DUALMESH is a good synthetic material for diaphragm reconstruction, because its smooth surface prevents adhesions to the lung and its rough surface allows adherence to abdominal tissue
• Limitations the authors state:
  • Small number of cases
  • Short follow-up period and retrospective design
  • No comparison with other materials

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: Diaphragm, Surgical Resection, Pleural Mesothelioma, Lung Cancer.

Related studies

• Long-term results of chest wall reconstruction with DualMesh — T. Nagayasu, N. Yamasaki, et al. (2010)
• Thirty-day mortality underestimates the risk of early death after major resections for thoracic malignancies — R.R. McMillan, A. Berger, et al. (2014)
• Efficacy of intra-operative unilateral diaphragm plication for patients undergoing unilateral phrenicotomy during extended surgery — T. Tokunaga, N. Sawabata, et al. (2010)
• Chest wall resection---alloplastic replacement — L.H. Lampl, H. Loeprecht (1988)
• Follow-up of patients with resected thoracic malignancies — P.M. Claiborne, C.S. Fowler, et al. (2012)
• Identifying Thoracic Malignancies Through Pleural Fluid Biomarkers: A Predictive Multivariate Model — J.M. Porcel, A. Esquerda, et al. (2016)

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