Extended posterolateral?subcostal thoracotomy for extrapleural pneumonectomy: a surgical approach for radical operation of pleural mesothelioma

Extrapleural pneumonectomy is an essential procedure in multimodality therapy of malignant pleural mesothelioma. However, radical resection may be difficult in a standard posterolateral thoracotomy because the edge of the diaphragm is located in the dead angle of the pleural cavity. We have tried a subcostal thoracotomy following a posterolateral thoracotomy (extended posterolateral-subcostal thoracotomy) for extrapleural pneumonectomy. With extended posterolateral-subcostal thoracotomy, ideal surgical resection, with en bloc removal of the lung, parietal pleura, pericardium and diaphragm, can be performed radically, but safely, without a second thoracotomy. We conclude that extended posterolateral-subcostal thoracotomy is an effective approach for extrapleural pneumonectomy.