ABSTRACT
The incidence of malignant pleural mesothelioma (MPM) worldwide is expected to increase in the next two decades. The paradigm for treatment of this aggressive disease has evolved to include combined multimodality therapies, which offer the prospect of improved outcomes for selected patients with clinically localized disease. The extrapleural pneumonectomy (EPP) operation consists of the en bloc resection of parietal pleura, lung, ipsilateral pericardium, and hemidiaphragm, and the subsequent reconstruction of the defects left from the excised pericardium and diaphragm. Prior to beginning the operation, a thoracic epidural catheter is placed for optimal pain control. Central venous access is obtained, a pulmonary artery catheter is placed, an arterial line is established, and a Foley catheter is inserted into the bladder. The main intraoperative complications are bleeding and damage to the vital structures encountered during the operation. Bleeding is a common complication and hemostasis is meticulously evaluated throughout the procedure.
