Extrapleural Pneumonectomy
An extrapleural
pneumonectomy is a procedure to
treat mesothelioma that involves the removal of a lung, a portion of the diaphragm, the lining of the lungs (parietal
pleura) and the
lining of the heart (
pericardium). This is considered a drastic procedure, and it is only available to patients whose
cancer is confined to the chest cavity, and who are determined to be in a healthy enough condition to face the many risks of the
surgery.
An extrapleural pneumonectomy can slow the advancement of mesothelioma and improve overall quality of life in some patients, allowing better breathing and mobility. Various studies have shown a significant increase in survival rates among mesothelioma patients treated with a combination of extrapleural pneumonectomy, radiotherapy, and chemotherapy. Moreover, of all treatments for mesothelioma, extrapleural pneumonectomy has the highest instance of long-term, disease-free survival.
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However, the procedure is somewhat controversial, with some doctors declaring that the possible benefits from this technically demanding surgery do not justify the risks. These risks include hemorrhage (internal bleeding), respiratory failure, pneumonia, accumulation of pus in the chest cavity (empyema), blood clotting in the veins of the inner thigh or leg, or even death. In addition, the mesothelioma may recur after the operation. Alternatives to an extrapleural pneumonectomy include pleurectomy or other standard mesothelioma treatments.
Because of the complicated nature of the procedure, extrapleural pneumonectomies are usually done in larger medical centers with experience in this surgery. The procedure itself is a major operation requiring general anesthesia. It begins with a large incision in the chest, sometimes followed by the removal of the sixth rib to help expose the diseased lung and make enough space in which the surgeon can work. Next, the surgeon collapses the diseased lung, ties off its major blood vessels, and clamps the main bronchial tube, which is to be stitched or stapled shut later. The diseased lung is then cut away. Next, the lining of the chest wall is removed, and parts of the heart lining and diaphragm are cut away on the diseased side, to be replaced by patches of Gore-Tex synthetic material. The chest incision is closed with sutures, and a temporary drain in the chest cavity is inserted into the chest cavity. Patients are hospitalized between one to two weeks, and are given an epidural to control pain.