Diaphragmatic Herniation through Prosthetic Material after Extrapleural Pneumonectomy: Be Aware of Tumor Recurrence

Our plain-English summary of Diaphragmatic Herniation through Prosthetic Material after Extrapleural Pneumonectomy: Be Aware of Tumor Recurrence, by D. Pop, C. Cohen, A.S. Schneck, et al (The Thoracic and Cardiovascular Surgeon Reports, 2013).

The study

• Authors: D. Pop, C. Cohen, A.S. Schneck, A.S. Nadeemy, N. Venissac, J. Mouroux
• Journal: The Thoracic and Cardiovascular Surgeon Reports
• Published: 2013;2(1):38-9
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Extrapleural pneumonectomy (EPP) is indicated in selected group of patients with pleural mesothelioma. Diaphragmatic reconstruction represents a part of this complex operation. We present the case of a late diaphragmatic gastric herniation through prosthetic material after EPP.

In plain English

This case report from Hôpital Pasteur in Nice, France, described a 69-year-old man who had been treated two years earlier for histologically proven malignant pleural mesothelioma of epithelial type. That treatment included chemotherapy before surgery, extrapleural pneumonectomy (removal of the lung and its surrounding lining) with heated chemotherapy inside the chest, and external radiotherapy. The diaphragm was rebuilt with a Gore-Tex patch. The patient was admitted with intense left chest pain and nausea, and imaging showed the stomach had moved into the chest through a defect in the patch. At emergency surgery the stomach was put back, a small area of dead stomach tissue was removed and the defect was repaired. Biopsies from the chest showed no tumor. One month after discharge, a CT scan showed fluid and tumor spread in the abdominal lining. A biopsy confirmed the tumor had returned, and the patient died shortly after. The authors concluded that a late hernia through the patch after this operation is possibly not a mechanical problem but an early sign of mesothelioma returning in the abdominal lining. The article did not report the patient's 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: case report
• Who was studied: One 69-year-old man with histologically proven malignant pleural mesothelioma of epithelial type, treated in the Department of Thoracic Surgery, Hôpital Pasteur, Nice, France; dates not given
• Exposure: The article does not report asbestos or other exposure history. It describes the treatment the patient had received: neoadjuvant chemotherapy, extrapleural pneumonectomy with intrathoracic hyperthermic chemotherapy, and external radiotherapy, with the diaphragm reconstructed using a dynamic Gore-Tex patch.
• Main results:
  • Two years after the original surgery, imaging showed the patient's stomach inside the chest through a defect in the prosthetic diaphragm patch.
  • At emergency surgery a small zone of gastric necrosis was resected and the diaphragm defect was repaired. Biopsies from the thoracic cavity showed no tumor deposits.
  • The patient was discharged on the 14th postoperative day.
  • One month later a CT scan showed signs of ascites with peritoneal carcinomatosis.
  • A biopsy of a parietal peritoneal lesion confirmed tumor recurrence, and the patient died shortly afterward.
  • The authors suggested that the initial event may have been local abdominal recurrence, with growing microscopic peritoneal carcinomatosis raising abdominal pressure and pushing the stomach through the patch.
• The authors' conclusion: The authors concluded that a late diaphragmatic hernia through the dynamic double-patch after extrapleural pneumonectomy is possibly not a mechanical problem but an early sign of peritoneal recurrence of pleural mesothelioma.
• Limitations the authors state:
  • The authors noted that they first thought the cause was mechanical failure of the patch, and that no biopsies were taken from the abdomen during the hernia surgery.

Topics

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma.

Related studies

• A case of cardiac herniation after extrapleural pneumonectomy for malignant thymoma — S. Sonoda, Y. Kumagawa, et al. (2010)
• Cardiac herniation after extrapleural pneumonectomy — N. Nishizawa, T. Osaki, et al. (2020)
• Laparoscopic repair of gastric herniation after extrapleural pneumonectomy for mesothelioma — M. Egan, B.E. Louie, et al. (2012)
• Cardiac herniation identified without any symptoms following extrapleural pneumonectomy: a case report — R. Tokuda, S. Ikebe, et al. (2025)
• A new technique of diaphragmatic patch fixation in extrapleural pneumonectomy — M. Schiavon, A. De Filippis, et al. (2010)
• Second surgery for recurrence of malignant pleural mesothelioma after extrapleural pneumonectomy — L. Politi, G. Borzellino (2010)

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