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Cerra-Bergueiro D, Rama-Maceiras P, López-López D, Gestal-Vázquez M, Diaz-Allegue M, Delgado-Roel M. Gastric herniation due to rupture of diaphragmatic prosthesis in the postoperative period of pleuropneumonectomy due to mesothelioma: A complication to consider. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:156-159. [PMID: 36842686 DOI: 10.1016/j.redare.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/15/2021] [Indexed: 02/28/2023]
Abstract
Extrapleural pneumonectomy, usually associated with pericardial and diaphragmatic reconstruction with prosthetic material, is one of the surgical techniques used in the treatment of malignant pleural mesothelioma. Herniation of the abdominal viscera towards the thorax through the prosthetic material at the diaphragmatic level is a rare but potentially serious complication of these procedures, which must be diagnosed quickly for urgent repair. We present the case of a patient who presented with gastric herniation in the early postoperative period of a left pneumonectomy due to pleural mesothelioma. The clinical findings were mild, but supported by imaging tests, they confirmed the diagnostic hypothesis and facilitated the solution of the condition. Possible contributing factors are reviewed and the need for early diagnosis and treatment is emphasized to avoid ischemia of herniated abdominal viscera in the thoracic cavity, due to the risk of necrosis and contamination by fecaloid material.
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Affiliation(s)
- D Cerra-Bergueiro
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - P Rama-Maceiras
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - D López-López
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M Gestal-Vázquez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M Diaz-Allegue
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M Delgado-Roel
- Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
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Mangiameli G, Bottoni E, Voulaz E, Cariboni U, Testori A, Crepaldi A, Giudici VM, Morenghi E, Alloisio M. Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas's Experience. J Clin Med 2021; 10:jcm10214968. [PMID: 34768488 PMCID: PMC8584559 DOI: 10.3390/jcm10214968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We analysed a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent extended Pleurectomy/Decortication (eP/D) in a centre with a high level of thoracic surgery experience (IRCCS Humanitas Research Hospital) to explore postoperative morbidity and mortality, pattern of recurrence and survival. METHODS A retrospective analysis was performed on MPM patients underwent eP/D in our centre from 2010 to 2021. All patients were identified from our departmental database. Postoperative complications were scored according to Clavien-Dindo criteria. Survival analysis was performed by the Kaplan-Meier methods and Cox multivariable analysis. RESULTS Eighty-five patients underwent extended pleurectomy decortication (eP/D) during study period. Macroscopical residual disease (R2) was reported in one case. A neoadjuvant chemotherapy regiment was administrated in 88% of the surgical cohort. A complete trimodality treatment including induction with platinum agents and pemetrexed, radical cytoreductive surgery and volumetric modulated arc therapy technology (VMAT) could be administered in 63 patients (74%). Postoperative morbidity rate was 54.11%, major complications (defined as Clavien-Dindo ≥ 3) were reported in 11 patients (12.9%). Thirty-day mortality and 90-day mortality were, respectively, 2.35% and 3.53%. Median disease-free and overall survival were, respectively, 13.7 and 25.5 months. The occurrence of major complications (Clavien-Dindo ≥ 3), operative time, pT3-T4, pathological node involvement (pN+) were prognostic factors associated with worse survival. CONCLUSIONS In our experience, eP/D is a well-tolerated procedure with acceptable mortality and morbidity, allowing for the administration of trimodality regimens in most patients. eP/D offered in a multimodality treatment setting have satisfactory long term oncological results. To obtain best oncological results the goal of surgery should be macroscopic complete resection in carefully selected patients (clinical N0).
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Affiliation(s)
- Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy
- Correspondence: ; Tel.: +39-02-82247585
| | - Edoardo Bottoni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
| | - Emanuele Voulaz
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
| | - Alessandro Crepaldi
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
| | - Veronica Maria Giudici
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
| | - Emanuela Morenghi
- Biostatistic Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy;
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy
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