Lobectomy for Mesothelioma
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For patients with resectable mesothelioma, several surgical procedures may be used to remove as much malignant tissue as possible.[1] Not all patients are eligible for surgery based on how much cancer has spread, but for some, a lobectomy may slow tumor growth, relieve symptoms, and extend survival time.
Surgical Procedures for Pleural Mesothelioma
Mesothelioma patients often receive a multi-modal approach to treatment. This means using a combination of two or more treatment modalities, most often with chemotherapy, surgery, and radiation therapy.
The goals of surgery and the procedure chosen depend on the stage of the cancer and the patient’s health and preferences.
Surgery for mesothelioma might be curative if the patient received an early diagnosis. For instance, an extrapleural pneumonectomy removes a significant amount of tissue and may lead to remission.
For later stages, surgical procedures are considered palliative to relieve symptoms associated with mesothelioma while extending life as possible.[2]
Most mesothelioma patients are somewhere between the two extremes. A surgery, such as a lobectomy, may be used to remove as much malignant tissue as possible to reduce symptoms. This procedure can improve survival times.
What Is a Lobectomy?
Many different surgical procedures help manage or treat lung conditions like mesothelioma. A lobectomy is a surgery that removes one entire lobe of a lung.
The lobes are the segments of each lung. The left lung has two lobes, while the right lung has three. A lobectomy leaves a significant portion of lung tissue intact, allowing mostly normal function.[3]
A surgeon may perform a lobectomy when a condition, such as mesothelioma, affects only part of the lung. It often requires a thoracotomy, a complete opening of the chest, which is invasive and risky. A minimally-invasive approach is safer.
In some cases, the surgery may be minimally invasive. VATS, or video-assisted thoracoscopic surgery, involves smaller incisions and tools.[3]
Who Can Benefit from a Lobectomy?
Pleurectomy/decortication is a primary surgical treatment for mesothelioma that involves removing the pleural tissue, followed by any tissue with tumors. A lobectomy is another option.
Lobectomy Treatment for Early-Stage Pleural Mesothelioma
Mesothelioma is rarely curable, but in rare cases of an early diagnosis, a surgery like a lobectomy gives a patient a chance of remission. It can also extend a patient’s life and provide relief from symptoms.
The goal is to remove as much of the malignant tissue as possible to slow cancerous growth and extend the patient’s life expectancy. A surgeon may also choose to do a lobectomy during this procedure.[4]
In rare cases, a lobectomy may be performed with the intent to cure pleural mesothelioma. A case study of a patient with pleural mesothelioma described how his doctors performed a lobectomy to cure the cancer.
This was only thought possible because the tumor was localized. This meant that just one lobe could be removed without leaving a lot of tumors behind. One year later, the patient was doing well and had no recurrence of cancer.[4]
Lobectomy to Extend Patient Life Expectancy
Localized mesothelioma that can be cured by a lobectomy is extremely rare and not often reported. In most cases, a lobectomy is not a curative procedure.
However, it can slow the progression of the disease. This helps patients live longer, even if they never achieve remission. They often also receive chemotherapy, radiation, or immunotherapy.
Palliative Care
A third type of patient who can benefit from a lobectomy gets relief from mesothelioma complications and symptoms. The surgery provides relief and a better quality of life. This is known as palliative care.
By removing tumors and masses, the patient experiences less pain and other side effects for the time they have remaining.
The Risks of a Lobectomy
Any major surgery comes with risks. An invasive lobectomy with thoracotomy is riskier, while the VATS strategy is less risky because it doesn’t require opening the chest. Potential risks of any lobectomy surgery include:[3]
- Infections
- Excessive bleeding
- Air between the pleura, which may lead to a collapsed lung
- A bronchopleural fistula, a hole between the airway and pleura
- Empyema, pus collected in the chest cavity
- Pleural effusion, fluid between the lung and chest wall
- Pain, including long-term, chronic pain
- Damage to organs near the surgery site
- Risks of general anesthesia, including pneumonia, blood clots, stroke, and heart attack
It is important to weigh the benefits and the risks when deciding on a lobectomy or any surgical procedure. The risks are often worth the potential benefits for many mesothelioma patients, mainly because treatment options are limited. Use your medical team’s guidance to make the best choice.
What Is the Mortality Rate for a Pleural Mesothelioma Lobectomy?
Although it is less extensive and aggressive than some other procedures, a lobectomy is still a very intensive procedure. It comes with serious potential risks, including death. This is something patients must consider when choosing from among treatment options.
Compared to more extensive surgery, lobectomy has a lower mortality rate. Several studies have compared the mortality rate after pneumonectomy versus lobectomy. Pneumonectomy is a surgery to remove the entire lung.
These studies report a mortality rate of 5% to 7% for lobectomy compared to 10% to 15% for pneumonectomy.[5] Lobectomy results in fatalities less often, but it is still a potential complication.
Recovering from Lobectomy Surgery
If you undergo a VATS lobectomy for mesothelioma, recovery time will be less than if the surgery is more invasive. The type of surgery, any complications, and your overall health determine how long you need to stay in the hospital. It could be days or weeks.
Surgeons and hospital systems that perform higher mesothelioma cases might have specialized protocols to have patients go home sooner.
You will need to keep the incision sites clean and dry and monitor for signs of complications at home. Seek medical attention if you develop a fever, if the incision site swells, turns red, bleeds, or is painful, if you have difficulty breathing or shortness of breath, or if you have unusual chest pain, coughing, or mental confusion.
A lobectomy is a surgical procedure that may sometimes be used in a multi-modal approach to treating and managing pleural mesothelioma. It is rarely curative. However, in some instances, it might provide symptom benefits. Talk to your medical team if you have questions about this procedure or if you wonder if it is right for you.
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Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.