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Stages I and II malignant pleural mesothelioma (MPM) can be satisfactorily treated with extended
extrapleural pneumonectomy (EPP). We modified our diagnostic methods and surgical techniques to improve outcome.
74 patients were treated with EPP, 33 from 1988 to May 2000 (first group), and 41 from June 2000 to 2010
(second group) and all underwent thoracoscopy without mediastinoscopy or laparoscopy prior to EPP. We began to make
changes in surgical management in group 2 (2000-2010). Staging was improved using 3D CT scan and Standard Uptake
Values (SUV) provided by 2-[Fluorine-18]fluro-2-deoxy-D-glucose positron emission tomography (FDG PET) scan. Talc
pleurodesis was used preoperatively in 15 cases. Double unilateral thoracotomy, performed on 24 patients, facilitated
dissection of the diaphragm and made alterations in the reconstructive phase possible. Polytetrafluoroethylene (PTFE)
prostheses were used instead of biological materials. In 10 cases the pericardium was not reconstructed on the left side
after the previous negative experience of functional pericardial concretio that needed the prosthesis removal (Table 1).
Topical thrombin was used to reduce postoperative complications whereas posterior prosthetic packing was used to
prevent paraprosthetic evisceration and reduce postoperative bleeding.
Patients of group 2 experienced less morbidity. Fourteen of the 71 patients who survived beyond the immediate
postoperative period lived at least 3 years. Potential positive prognostic factors were identified at follow-up.
The innovations we adopted, especially the reconstruction procedures, improved the outcome for our series
of patients who underwent extended EPP for MPM. Follow-up results suggest that the MIB-1 index, stage 1 disease,
prosthetic diaphragmatic replacement, adjuvant radiotherapy and control are important positive prognostic factors.