Mesothelioma Pneumonectomy

A pneumonectomy is the surgical removal of all or part of a lung, usually performed as a cancer treatment. Because this mesothelioma surgery will significantly reduce the patient's breathing capacity, mesothelioma doctors will choose less extreme options if available. Before committing to a pneumonectomy, the oncologist will order extensive testing in order to insure that the remaining lung will have enough capacity to take over the respiration process.

A pneumonectomy may either be of the traditional or extrapleural type. A traditional pneumonectomy consists of removing the affected lung only; an extrapleural pneumonectomy involves the removal of the diseased lung along with a portion of the pericardium (membrane covering the heart and affected in pericardial mesothelioma), part of the diaphragm, and the parietal pleura (membrane lining the chest cavity) on the same side of the chest. This is sometimes the best treatment option for malignant pleural mesothelioma patients.

An extrapleural pneumonectomy can slow metastasis (spreading) in mesothelioma cases and allow the patient to breathe more easily. Studies indicate that mesothelioma patients treated with a combination of extrapleural pneumonectomy, radiotherapy, and mesothelioma chemotherapy enjoy better survival rates. Of all mesothelioma treatments, extrapleural pneumonectomy allows for the highest survival rates.

Extrapleural pneumonectomies are usually done in larger cancer centers with better facilities, since these procedures are quite complicated. The operation requires general anesthesia; the surgeon begins by making a large incision in the chest and may need to remove the sixth rib in order to help expose the diseased lung and make enough space for the procedure. Next, the surgeon collapses the diseased lung, ties off its major blood vessels, and clamps the main bronchial tube, which will later be stapled. The diseased lung is then cut away. Lining of the chest wall that is removed as well as parts of the pericardium and diaphragm are replaced by patches of synthetic material. The chest incision is closed with sutures, and a temporary drain is inserted into the chest cavity.

Patients are administered an epidural anesthetic for pain in the days following the operation; recovery normally requires a two-week hospital stay.

Sources

"Pneumonectomy." Harvard Medical School.
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