Doctors primarily use two different tumor-removing surgeries for pleural mesothelioma: Extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). Roughly 15 to 20 percent of people with pleural mesothelioma qualify for tumor-removing surgery.
A general term for a surgery that allows doctors to access a patient’s lungs, heart, aorta, trachea or diaphragm is “Thoracotomy”. It involves making an incision 4–10 inches long on either side of the chest. Extensive procedures, such as EPP and P/D, require a thoracotomy. The first step in several asbestos-related lung cancer surgeries is also a thoracotomy. These surgeries include pneumonectomy, lobectomy, wedge resection, and segmentectomy.
Unfortunately, up to 25 percent of mesothelioma patients cleared for surgery are found to be inoperable after a thoracotomy is performed. Doctors try to predict this with the latest advances in imaging technology and other diagnostic techniques, however, surgeons cannot determine whether a planned tumor-removing surgery is actually possible until they look inside the patient.
In cases where cancer has spread too far for surgery to help, the surgeons will pinpoint the stage of cancer. This can guide the patient’s overall treatment plan. If the cancer is localized, however, the surgeons will proceed with the tumor removal.
Pneumonectomy involves removing a lung. A patient may qualify for this surgery if cancer hasn’t spread beyond one lung. Most surgeons perform more extensive EPP (Extrapleural pneumonectomy) surgery rather than just a pneumonectomy.
Extrapleural pneumonectomy (EPP)
This is an aggressive surgery that removes an entire lung, the lining around it, nearby lymph nodes and parts of the pericardium and diaphragm. Hypothetical, it offers the best chance to remove all cancer cells, but it also permanently reduces the patient’s stamina.
This procedure was developed to be a less aggressive alternative to removing a lung. Surgeons remove the pleural lining around the lungs and all visible tumors rather than the entire lung. They scrape the affected lung rather than remove it.
The average hospital stay after a thoracotomy is five to ten days. These surgeries irritate nerve endings near the incision, so the patient will likely experience pain, numbness or burning below their breast and at the front of their rib cage.
Drainage from the incision of clear or pink fluid is normal. You should clean your incision in the shower, washing gently with warm water and mild soap. Avoid submerging the incision in a bathtub or spa for three weeks. Avoid heavy lifting and other strenuous activities for eight weeks. These could put stress on your incision and delay recovery. You can perform breathing exercises and walk every day to improve your strength, circulation and lung capacity.