Malignant pleural mesothelioma: Is reconstruction of the diaphragm necessary in left pleurectomy/decortication? A case report

Our plain-English summary of Malignant pleural mesothelioma: Is reconstruction of the diaphragm necessary in left pleurectomy/decortication? A case report, by A. Testori, M. De Simone, E. Bottoni, et al (Clinical Case Reports, 2019).

The study

• Authors: A. Testori, M. De Simone, E. Bottoni, M. Alloisio, E. Voulaz, U. Cioffi
• Journal: Clinical Case Reports
• Published: 2019;7(2):299-301
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We describe a case of complete intrathoracic stomach and intestinal herniation after pleurectomy/decortication due to diaphragm reconstruction without mesh. Is reconstruction with mesh always necessary? Can lung sparing obviate the tension on residual diaphragm? These are the questions not well described to which we try to give an answer.

In plain English

This case report described one patient, a 50-year-old woman with malignant pleural mesothelioma. The article does not mention asbestos exposure. After three cycles of chemotherapy, the patient had a left pleurectomy/decortication, an operation that removes the lining around the lung but keeps the lung. The disease had spread into the diaphragm, so part of it was removed, and the remaining muscle was stitched closed without a mesh. Four days after surgery the patient had chest pain and shortness of breath. A CT scan showed that the stomach and intestine had moved entirely up into the chest. In a second operation the surgeons placed a polypropylene mesh under the diaphragm. The patient left hospital ten days later with the herniation resolved. The authors reported that this was their first diaphragm breach with bowel herniation in about 70 such operations over 8 years. The authors concluded that they believe mesh reconstruction is necessary in left pleurectomy/decortication, and that chest X-rays should be taken every day after surgery until discharge. They said they were unsure whether the complication came only from how much muscle was removed.

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 50-year-old woman with no other illnesses and malignant pleural mesothelioma confirmed by pleural biopsy. She was treated by the authors' surgical team (authors based in Milan, Italy). Dates are not given.
• Main results:
  • After three cycles of carboplatinum and pemetrexed, the patient had a left pleurectomy/decortication. The tendinous part of the diaphragm was completely removed and the muscle partly removed. The remaining muscle was closed with an absorbable suture, without mesh.
  • On the fourth postoperative day the patient had chest pain and dyspnea. A CT scan showed complete intrathoracic stomach and intestinal herniation.
  • At reoperation, a polypropylene mesh was placed under the diaphragm and fixed to its abdominal side. The patient was discharged after ten postoperative days with complete resolution of the herniation.
  • The authors had done about 70 pleurectomy/decortication cases over 8 years. Before this case they had never recorded diaphragmatic damage requiring mesh. This was their first case of diaphragm breach with bowel herniation.
• The authors' conclusion: The authors concluded that they believe mesh reconstruction is necessary for left pleurectomy/decortication. They also concluded that chest X-rays should be performed every postoperative day until discharge.
• Limitations the authors state:
  • The authors stated they were not sure whether the complication depended only on the extent of diaphragm muscle removal.
  • The authors noted there is no clear evidence in the literature about diaphragm reconstruction during pleurectomy/decortication.

Topics

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

Related studies

• Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas's Experience — G. Mangiameli, E. Bottoni, et al. (2021)
• Efficacy of Intraoperative Hypertonic Glucose Solution Administration on Persistent Air Leak After Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: A Retrospective Case-Control Study — A. Testori, G. Perroni, et al. (2021)
• Surgical Management and Reconstruction of Diaphragm, Pericardium and Chest Wall in Mesothelioma Surgery: A Review — P. Bertoglio, E. Garelli, et al. (2021)
• Diaphragm reconstruction by GORE DUALMESH in patients undergoing resection for thoracic malignancies — A. Sano, Y. Azuma, et al. (2021)
• Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma — E. Taioli, A.S. Wolf, et al. (2015)
• A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma — V. Rusch, L. Saltz, et al. (1994)

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