Abstract
We report a case of video-assisted thoracoscopic extrapleural pneumonectomy for diffuse malignant pleural mesothelioma. A 55-year-old man had dyspnea due to right pleural effusion. Chest tube drainage was performed after admission. Cytology for pleural effusion was diagnosed as class V (adenocarcinoma). Because there was no primary malignant lesion, we performed a diagnostic thoracoscopic examination. Histology of the pleural biopsy showed malignant pleural mesothelioma of the epithelial type, and the preoperative stage was identified as stage I. An extrapleural pneumonectomy with reconstruction of the diaphragm and pericardium was successfully performed using video-assisted thoracoscopic techniques. All surgical procedures were performed using only three surgical wounds (5, 5, and 7 cm) without the use of a rib spreader. The patient was discharged on postoperative day 13 without any complications. He underwent 3 courses of adjuvant chemotherapy using cisplatin and pemetrexed 3 weeks or later after surgery. The patient is currently alive without signs of recurrence at 6 months after surgery. Video-assisted thoracoscopic extrapleural pneumonectomy may be feasible in selected patients in the early stage of diffuse malignant pleural mesothelioma.
