Bilateral thoracoscopy, mediastinoscopy and laparoscopy, in addition to CT, MRI and PET imaging, are essential to correctly stage and treat patients with mesothelioma prior to trimodality therapy.

Background: Trimodality therapy (TMT; extrapleural pneumonectomy (EPP), chemotherapy and radiation therapy) offers the potential of optimal survival in selected patients with Brigham stage I-II epitheliod mesothelioma based on CT, MRI and PET scanning. We hypothesized that these scanning modalities were inadequate to accurately stage these patients.

Methods: Patients suitable for TMT, in addition to CT, MRI and PET scanning, prior to EPP, underwent bilateral thoracoscopy, mediastinoscopy and laparoscopy (surgical staging).

Idiopathic postpneumonectomy pulmonary edema: hyperinflation of the remaining lung is a potential etiologic factor, but the condition can be averted by balanced pleural drainage.

Objectives: Idiopathic postpneumonectomy pulmonary edema is a leading cause of mortality after pneumonectomy. Postoperative hyperinflation of the remaining lung is an etiologic factor. We have demonstrated avoidance of postpneumonectomy pulmonary edema solely by changing management of the pneumonectomy space to a balanced drainage system.