Continued from: Mesothelioma Treatment
A pneumonectomy (or pneumectomy) is a type of surgical procedure that involves the removal of a lung. First performed in 1985, this surgery is used most often to remove cancerous lung tissue. Extrapleural pneumonectomy is a type of pneumonectomy that has been performed for the last 30 years, almost exclusively for the treatment of malignant pleural mesothelioma.
Whereas lung cancer affects the lung tissue itself, malignant pleural mesothelioma affects the pleura, which is a serous membrane separating the lung from other organs in the chest and abdominal area. Mesothelioma is not actually a lung cancer but can potentially spread to the lungs after the cancer in the pleura has metastasized. Therefore, a standard pneumonectomy calls for the sole removal of the cancerous lung, while an extrapleural pneumonectomy calls for the removal of the cancerous pleural tissue and the lung closest to the affected area. The removal of a lung that results from an extrapleural pneumonectomy is designed to minimize any further spread of malignant mesothelioma.
No ideal treatment modality exists for malignant pleural mesothelioma; however, extrapleural pneumonectomy used as part of a trimodality treatment that includes chemotherapy and radiation therapy is the best method for prolonging patient survival.
Extrapleural pneumonectomy surgery is an option for a select few. Early-stage malignant pleural mesothelioma patients with resectable cancer formation (capable of being surgically removed) are the best candidates for extrapleural pneumonectomy surgery.
Epithelial cancer cells are the most common cancer cell subtype associated with malignant mesothelioma, as opposed to the more serious subtypes, sarcomatous and desmoplastic. A number of operative centers choose to perform extrapleural pneumonectomy procedures only on patients with epithelioid cancer because of the low post-extrapleural pneumonectomy survival time of the other two.
Extrapleural pneumonectomy surgeries are incredibly invasive, requiring a great deal of preoperative and postoperative treatment. Patients are given a general anesthesia to limit preoperative pain and discomfort. For management of postoperative pain, a thoracic epidural catheter is inserted before the operation.
Extrapleural pneumonectomy surgery itself begins by entering the chest over the unrestricted sixth rib (occasionally the sixth rib is removed). Extrapleural dissection follows, during which the surgeon takes great care to avoid entering the pleural cavity, as this could cause spillage of malignant cells within the operative field. The parietal pleura (lining of the lung) is removed along with the pericardium (lining of the heart), the diaphragm (the muscle that assists with breathing) and the appropriate lung (dependent on affected side of the chest).
Postoperative care of extrapleural pneumonectomy patients is similar to that of patients recovering from a standard pneumonectomy procedure. Postoperative patients are at risk of developing dangerously low blood pressure (hypotension) resulting from reconstruction of the pericardium. If a postoperative extrapleural pneumonectomy patient experiences hypotension, immediate follow-up surgery is needed.
Managing a patient's pain is the most important postoperative concern. If pain is not controlled, it could lead to the collapse of the remaining lung (called postoperative atelectasis). On the second day following extrapleural pneumonectomy, patients begin pulmonary rehabilitation to restore heart function to normal levels. Postoperative treatment can require a hospital stay of five to ten days.
Trimodality therapy that includes extrapleural pneumonectomy surgery, chemotherapy and radiation therapy is the most effective way to increase the survival time of early stage malignant pleural mesothelioma victims. If successful, patients could experience a five-year survival time, compared with the one- to two-year survival time that is standard with malignant mesothelioma.
[Page updated November 2005]