“Lower door open thoracotomy”: a feasible approach for extra-pleural pneumonectomy

Giovanni Leuzzi, Kenji Kawamukai, Calogero Porrello, Sergio Forti Parri, Gian Marco Guiducci, Nicola Lacava

Abstract

We read with great interest the article by Bedirhan et al. (1) reporting on a series of 76 patients undergoing surgical treatment for malignant pleural mesothelioma (MPM). Nowadays, although different therapeutic options are available (chemotherapy, radiotherapy, surgery, photodynamic, immune- and gene therapy), a definitive treatment for patients affected by MPM remains controversial (2). As well, in order to compare different surgical strategies, randomized clinical trials with a large number of patients are hardly feasible due to high morbidity rate related to each surgical procedure (3). To date, radical surgery with extra-pleural pneumonectomy (EPP) and adjuvant treatments has become the preferred option in early disease, but the benefits of such an aggressive approach have been discussed because of significant treatment-related morbidity and mortality (4).