Reconstruction of diaphragm with cadaveric fascia lata during extended surgery for pleural mesothelioma: A single-center experience

Synthetic materials have traditionally been used to reconstruct the diaphragm during extensive surgery for pleural mesothelioma. However, new biomaterials have shown promising results in various surgical fields. This study describes our experience using homologous fascia lata for diaphragm reconstruction in patients undergoing surgery with radical intent for pleural mesothelioma. Data from patients who underwent extensive surgery for pleural mesothelioma requiring diaphragm reconstruction from January 2021 to December 2023 were extracted and analyzed. Patients were divided in two groups based on the type of material used for diaphragm reconstruction: expanded polytetrafluoroethylene (ePTFE) and cadaveric homologous fascia lata. Forty-three consecutive patients were included in the analysis. Of these, 22 patients (51 %) underwent diaphragm reconstruction with expanded ePTFE prostheses, while 21 patients (49 %) had reconstruction using homologous fascia lata. No significant differences were found between the two groups in terms of in-hospital stay (14.5 vs 17 days, p = 0.865) and early post-operative complications (19 % vs 18 %, p = 0.943). Concerning long-term complications, a lower rate was found in the group treated with fascia lata (5 % vs 23 %, p = 0.09). Diaphragm reconstruction using cadaveric homologous fascia lata after extended surgery for pleural mesothelioma is feasible and results in satisfactory post-operative outcomes. Although the trend suggests fewer long-term complications with fascia lata, further research is needed to confirm these findings and determine the ideal prosthetic material for diaphragm reconstruction.