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Pneumonectomy - Mesothelioma surgery
Another surgical cancer treatment, pneumonectomy, involves the removal of the entire lung. It is divided into two types:
1) traditional, involving the simple removal of only one affected lung;
2) extrapleural (also known as pleuropneumonectomy), that directs the areas of the diaphragm, and the the heart covering to be removed together with the diseased lung.
The pneumonectomy is applied to malignant mesothelioma cases. Malignant mesothelioma is a kind of cancer that affects the membrane lining the lungs (the pleura). The pneumonectomy, applied to this disease does not simply remove the affected lung, but it also involves the removal of the part of the membrane covering the heart (pericardium), piece of the diaphragm and the parietal pleura (which is the membrane covering the chest cavity) located on the same side of the chest. The name of this procedure is extrapleural pneumonectomy.
EPP (or extrapleural pneumonectomy) doesn't suit any mesothelioma patient, being an extensive surgery. This treatment is appropriate in case the patient has not more than TNM stage T3,N1. This includes the whole stages 1 and 2 mesothelioma, as well as some cases of stage 3 mesothelioma. This is not the cure of mesothelioma but this means can reduce the speed of tumor growth and improve the quality of life for the patient for longer time. Pneumonectomy involves the removal of the lung. The word extrapleural describes that it involves pleura or pericardium (the diaphragm, covering of the heart) is also to be removed from the side which is affected by the disease.
This operation can be performed only in case the patient's heart and lung function are good enough to fit the operation. In case the patient's heart and lung function are not enough then the operation can only harm him or her instead of fighting the disease.
The trial over extrapleural pneumonectomy is now about to start. All the participants are going to be subjected to some form of surgery, chemotherapy and radiotherapy. ? of them are going to be subjected to additional pneumonectomy and an intensive course of radiotherapy. The aim of this trial is to find out whether the applying of major surgery provides improvement or not and whether it lets slow down the disease or control its symptoms within the long period. It will also let the researchers find out if EPP is better than any other surgical method allowing control the disease.
The survival rate may be increased in case adjuvant therapy (chemotherapy and/or radiation) follows EPP, though it is associated with high risk (over 15%) of death that may occur during the operation or in a short time after it. That's why the majority of the patients in the Stage I are not subjected to this procedure, as far as major surgery is still available for them.
In most of the cases EPP is not provided for patients over 55 years old or for those who has the disease that progressed over Stage I, as far as the risk of dealing with the older patient is generally increased, moreover there is a specific risk connected with EPP.
A considerable preoperative testing and evaluation are required due to the radical nature of EPP. An MRI of the chest, pulmonary function tests, and echocardiography are the necessary preoperative researches for patients.
16 months is an average survival rate for the patients after EPP, though patients with mesothelioma of epithelial subtype, which is a type of mesothelioma affecting part of the lining of the respiratory system, have a higher survival rate - up to 24 months. For those patients with epithelial mesothelioma who had no involvement of the lymph nodes the survival rate increases up to 5 years after surgery in 45% of cases.
The more extensive surgery than pleurectomy is extrapleural pneumonectomy in which lung, pleura, and cancer as a whole are also surgically removed. Extrapleural pneumonectomy can be the alternative treatment in case the cancer has already advanced into the lung and pleurectomy can not be an option. Surgery used to go along with risk but modern techniques of anesthesia and surgery decrease complications rate and mortality down to 5% of cases.
Extrapleural pneumonectomy does not cure the disease when used alone, even in case it is applied in its first stages, though it gives a considerable relief from symptoms in various degrees. Today surgery is mostly used as a part of a multi-modality treatment in order to decrease the size of the tumor and to direct chemotherapy or radiation therapy in the way described further.
Pleurectomy has never been compared to extrapleural pneumonectomy during clinical trials, though non-comparative researches prove that the survival without cancer in case of extrapleural pneumonectomy is better than in case of pleurectomy.
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