Mesothelioma Pneumonectomy

A surgery performed in order to remove a lung is called Pneumonectomy (or Pneumectomy). The circumstances that require this type of surgical intervention, most often, are related to the presence of cancerous lung tissue. When cancer is present in the pleura or lining that encases the lungs, the disease is termed malignant pleural mesothelioma. Pneumectomy has been the preferred treatment for such patients over the last 30 years and the specific term used for it is Extrapleural pneumonectomy, a type of pneumonectomy.

Pneumectomy & Extrapleural Pneumenoctomy

To differentiate between Pneumectomy and Extrapleural pneumonectomy, the former involves the cutting out of the lung owing to the cancerous cells detected in the lung tissue of the organ. Extrapleural pneumonectomy, on the other hand, involves cutting of the cancerous pleural tissue primarily owing to the presence of cancerous cells in the lining covering the lungs; the portion of the lung closest to it that may have acquired secondary infection, may also be removed.

Malignant pleural mesothelioma begins from the pleural but spreads quickly to nearby organs. In Extrapleural pneumonectomy, the main focus is therefore on the lining; the surgery of the lung or other organs in the chest and abdominal area is only to contain and minimize further metastasizing.

While no cure exists for malignant pleural mesothelioma, the trimodal approach for treatment includes extrapleural pneumonectomy along with mesothelioma chemotherapy and radiation therapy. At present, this is the only means available to prolong patient survival rate.

Extrapleural Pneumonectomy Patients

Not all mesothelioma pacients can benefit of the extrapleural pneumonectomy surgery . Those in the early stages of the disease and with cancer capable of being surgically removed (resectable type) are considered by mesothelioma doctors as the most suitable. In addition, the type of cancer cells is preferred to be the epithelial cancer cells. Such patients have been known to survive better than those with sarcomatous and desmoplastic type of cells, which are generally considered the more serious subtypes.

Selection of the most receptive patient for Extrapleural Pneumonectomy is critical as it is a complicated procedure that spans extensive preoperative and postoperative mesothelioma treatment. A general anesthesia is administered prior to operation and a thoracic epidural catheter is also inserted at the same time for postoperative pain management. The surgical incision is done over the unrestricted sixth rib or by removing the sixth rib at times. During extrapleural dissection, the surgeon’s skill lies in not entering the pleural cavity. Any invasion into the pleural cavity could lead to spillage of mesothelioma malignant cells within the operative field. To prevent this, lining of the lung is removed as is the lining of the heart, the diaphragm that separates the chest cavity from the abdomen, as well as the infected lung.

In the postoperative phase, pain management and hypotension are the primary concerns. Pulmonary rehabilitation to restore heart function to normal levels is begun on the second day out of the total five to ten days of the mandatory hospital stay.