Treating Mesothelioma - Surgery - Pneumonectomy

Mesothelioma is a rare form of cancer that affects the membrane that covers and protects various internal organs of the body (mesothelium). The mesothelium is composed of two layers of specialized cells known as mesothelial cells. One layer directly surrounds an organ; the other forms a protective sac around the organ. The most common form of mesothelioma affects the membrane or sac that lines the lungs (pleura). Other common sites include the membrane lining the stomach (peritoneum) and the membrane lining the heart (pericardium).

Different types of treatments are available for patients with malignant mesothelioma. Some treatments are standard or current treatments while others are being tested in clinical trials. For this article we’ll discuss treating mesothelioma with pneumonectomy surgery. 

If localized malignant mesothelioma is found in more than one place in the chest, then, pneumonectomy surgery will be performed to remove the part of the lung that is diseased and part of the lining of the chest, the diaphragm, and the lining of the sac around the heart.

Pneumonectomy Procedure

While under general anesthesia, your surgeon will remove only the part of the lung that is diseased. The surgery is started by your surgeon cutting a large opening on the same side of the chest as the diseased lung which is called a posterolateral thoracotomy incision. This incision will reach from a predetermined point just below the shoulder blade around the side of your body along the curvature of the ribs at the front of the chest. It may be necessary for your surgeon to remove part of your fifth rib so that he or she has a more accurate view of the lung, making it easier to remove the diseased part of the lung.

Next, the diseased lung is deflated or collapsed; the major blood vessels to the lungs are tied off in order to prevent bleeding into the chest cavity. The main bronchus is clamped off in order to prevent fluid from entering in to the air passage. Your surgeon will make a cut through the bronchus to remove the diseased lung. Staples or stitches will be places at the end of the bronchus that has been cut. Your surgeon will make sure that air does not escape from the bronchus, then, he or she will insert a temporary drainage tube between the layers of the pleura called the pleural space to draw air, fluid, and blood out of the surgical cavity and finally the chest is closed and stitched or stapled shut.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy utilizes high-energy x-rays or other types of radiation that kill cancer cells. There are two forms of radiation therapy, external radiation therapy and internal radiation therapy. For external radiation therapy, a machine is used to send radiation toward the cancer; the machine is outside the body. For internal radiation therapy, a radioactive substance is placed directly into or near the cancer. The type and stage of cancer being treated will determine the way the radiation therapy is given.

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

'Treating Mesothelioma - Surgery - Pneumonectomy' Resources:
  1. The National Organization for Rare Disorders, Inc. (NORD) www.rarediseases.org
  2. National Cancer Institute (NCI), US Institutes of Health - "Mesothelioma: Questions and Answers"
  3. The Encyclopedia of Surgery, Advameg, Inc. - "Pneumonectomy"