Mesothelioma Treatments

Mesothelioma - Thoracotomy

Thoracotomy is a general term referring to a type of surgery in which an incision is made in the chest wall in order to gain access to the lungs, heart, aorta, trachea, or diaphragm. The incision may be performed on either side of the chest, depending on the purpose of the surgery. For mesothelioma patients it depends on the diseased lung, but will be on the side closer to that lung.


In the case of Mesothelioma there are three main types of lung surgery performed during the thoracotomy. If the mesothelioma cancer has not metastasized and is confined to a single area of the lungs, the least invasive thoracotomy option is a segmentectomy. Also know as wedge resection, this surgery leaves the patient with most of the affected lung intact. In this surgery a doctor removes a small slice of the lung, usually in a wedge shape, where the cancer is localized. In some cases, the segmentectomy can even be performed with an endoscope during a thorascopy. Although this option is ideal, it is rarely possible.

The excised portion of the lung is sent to a lab for a biopsy. A pathologist then determines whether the edges of the tissue are free of cancer. Edges that have no cancerous cells are called "negative margins" and mean that in all likelihood the cancer was fully removed. A positive margin, where cancer cells are found would indicate that the cancer was not all removed and immediate follow up procedures would be necessary.

Unfortunately, the chance of recurrence of the malignancy is higher for segmentectomy than for other forms of surgery. However, because only a small section of the lobe is removed, it may be the best option if the decrease in lung function that occurs with a lobectomy or pneumonectomy is too great a health risk.


The second kind of lung surgery is called a lobectomy. The lungs have five lobes, three on the right and two on the left. A lobectomy is the removal of an entire lobe. This technique can be used if the cancer is contained in a single lobe. It is riskier than a lobectomy, but it is more likely to result in full removal of a contained tumor. It is the most common of the three methods, providing most of the benefits of a segmentectomy, with it being only minimally more invasive, while providing most of the protection of a pneumonectomy for patients whose mesothelioma is limited to only a single lobe.


The third type of thoracotomy is the pneumonectomy. This procedure is by far the most invasive and the most dangerous because it involves the removal of an entire lung. It is only performed on patients whose mesothelioma has spread and where a lobectomy cannot reach all the cancer. The surgery requires an incision along the side of the patient's body from collarbone to the bottom of the rib cage.

The surgeon collapses the diseased lung and ties off the air supply that was reaching it. He also separates and ties off all the blood vessels that connected to that lung. Because mesothelioma is a disease of the mesothelium, the lining around the lung, the entire lung and lining are removed. In many cases the pericardium, the lining surrounding the heart, is also impacted and must be removed as well.

This is a very invasive surgery that involves serious risk. It involves considerable pain and the patient is usually given a catheter to bring painkillers into the body quickly and effectively enough to keep the pain controlled. Up to 40 percent of people who have this surgery have some sort of complication requiring more than the standard 24 hours in intensive care. Patients use a respirator for a day or two postoperative, and many complain about shortness of breath 6 months postoperative.

Following all three types of surgery, a tube remains in the chest to drain fluid and blood. This tube may need to stay in place for a few days. The procedures usually require a hospital stay of approximately two weeks and a recovery time of two to three months and longer for patients who experience complications.

For more information on the various thoracotomy procedures and the various other treatment options available to mesothelioma patients, please fill out the form on this page to receive a free comprehensive informative packet.

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