Mesothelioma Treatments

Mesothelioma Surgery - Pneumonectomy

Pneumonectomy is the medical term for the surgical removal of a lung. A pneumonectomy is most often used to treat all forms of lung cancer including mesothelioma when less radical surgery cannot achieve satisfactory results.

Extra pleural pneumonectomy surgery is only an option for some patients. Early-stage malignant pleural mesothelioma patients with resectable cancer formation (capable of being surgically removed) are the most likely to have successful extra pleural pneumonectomy surgery. First performed in 1985, an extra pleural pneumonectomy is a type of pneumonectomy that has been performed for the last 30 years almost exclusively for the treatment of malignant pleural mesothelioma.

The Procedure

In a conventional pneumonectomy, the surgeon removes only the diseased lung. An extra pleural pneumonectomy calls for the removal of the cancerous pleural tissue and the lung closest to the affected area. The removal of a lung that results from an extra pleural pneumonectomy is designed to minimize further spread of malignant mesothelioma. Since this type of pneumonectomy is even more invasive than a standard pneumonectomy, the recovery times may be somewhat extended and the complications slightly more severe.

Because extra pleural pneumonectomy is so invasive, a thoracic epidural catheter is inserted before the operation begins. This catheter is used to manage post-operative pain that can be extreme and enduring. The patient receives general anesthesia and an intravenous line inserted into one arm supplies fluids and medication during the operation, which usually lasts between one and three hours.

The surgeon begins the operation by opening the same side of the chest as the diseased lung. This incision extends from just below the shoulder blade around the patient's side, along the curvature of the ribs at the front of the chest. Occasionally the surgeon has to remove part of the fifth rib to get a clearer view of the lung so it can be more easily removed.

The doctor then collapses the diseased lung, ties off the lung's major blood vessels to prevent bleeding into the chest cavity, and clamps the bronchial tube to prevent fluid from entering the air passage. He then severs the bronchial tube and removes the lung. In an extra pleural pneumonectomy the lining of the lung is removed along with the pericardium, the lining of the heart, and the diaphragm, the muscle in the lower abdominal cavity that assists with breathing. A temporary drainage tube is inserted in the pleural space to allow any air, fluid, and blood to drain from the cavity left by the removal of the lung.

Recovery After Surgery

Patients generally remain in intensive care and on a respirator for at least 24 hours after the surgery to ease the strain on the chest and on the remaining lung. If everything goes well, the patient can move into a regular room within about a day or two. On the second day following extra pleural pneumonectomy, patients begin pulmonary rehabilitation to restore heart function to normal levels.

Complications including extended reliance on a respirator, heart arrhythmia, pneumonia, infection and blood clots occur in about 40 percent patients. Hypotension, extremely low blood sugar, is also a risk. For those patients who develop this condition, an immediate follow up surgical procedure is necessary.

Generally if none of these complications arise, the patient can be released in about 10 days. One complication that doesn't show up for some time is the physical movement of the patient's chest into the void left by the removed lung. This condition is called postpneumonectomy syndrome. The condition is remedied with the insertion of prosthesis to fill the void left by the missing lung.

Recovery is a slow process, with the remaining lung gradually taking on the work of the lung that has been removed. As the remaining lung gets stronger, the patient can start engaging in more regular non-strenuous activity. While some people who have desk jobs are able to return to work in as little as eight weeks, 60 percent of all pneumonectomy patients continue to struggle with shortness of breath six months after surgery.

To learn more about the recovery process and other types of treatment options available to mesothelioma patients, simply fill out the form on this page to receive a free comprehensive mesothelioma packet in the mail.

Survival Rate

The survival rate from surgery for patients who have had the left lung removed is between 96 and 98 percent. Removal of the right lung is more complicated and as a result right lung removal survival rates are between 88 and 90 percent.

People who combine this surgery with radiation and chemotherapy are commonly showing a five-year survival time, as compared with the 1 to 2 year survival time that is usually associated with mesothelioma.

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