Mesothelioma Thoracotomy

In surgery of the upper half of the body, when access to any of the organs like the lungs, heart, aorta, trachea, or diaphragm is gained from either side of the chest, the surgical procedure is generally called Thoracotomy. For patients diagnosed with mesothelioma, the affected part may be a diseased lung; so access to it for surgery requires thoracotomy from the side closer to the lung to be operated.

Thoracotomy types

Three main types of Thoracotomy are in use depending on the spread of the mesothelioma:

Segmentectomy: This technique is used to remove a small portion of the lung in cases where the cancer has not spread and is restricted to a specific area. Since the cut is usually a wedge-shaped piece, this thoracotomy option is also called wedge resection. It is the least dangerous surgical procedure of the three listed here owing to being less complicated.

The wedge-shaped piece removed from the body is sent for biopsy where an analysis to determine if spread of the cancer is done. If the pathologist finds the edges of the piece are free from cancer, a conclusion referred to as "negative margins" is derived indicating that the cancer has been removed completely. The risk of remission remains, however; cancer is more likely to come back but the procedure affords greater lung function for the patient.

Lobectomy: The human lung comprises of five lobes, three in the right lung and two in the left. If cancer is limited to a single lobe, the entire lobe may be surgically removed, giving the procedure the name: Lobectomy. It is a more risky procedure than segmentectomy but preferred when wedge resection does not serve the purpose of making the patient cancer free after surgery.

Pneumonectomy: The third type of thoracotomy is the most dangerous as it involves surgical removal of an entire lung. This is performed when cancer has encompassed the whole lung but has not yet metastasized to other organs. The affected lung has to be sealed and removed with great care by a highly skilled surgeon; often portions of the lining are also removed along with the lung. The down side of pneumonectomy is  that the patient will never regain total lung function.

Each of these three types of thoracotomy requires a chest tube to drain fluid and blood from the chest cavity for a few days post surgery. Hospital stay is also longer and recovery spans two to three months.