Lobectomy for Mesothelioma
For patients with resectable mesothelioma, there are several surgical procedures that may be used to remove as much malignant tissue as possible.[1] Not all patients are eligible for surgery based on how much the cancer has spread, but for some a lobectomy may slow tumor growth, relieve symptoms, and extend survival time.
Mesothelioma Surgical Procedures
Mesothelioma is most often treated with a multi-modal approach, a combination of two or more treatments, most often chemotherapy, surgery, and radiation therapy. The goals of surgery and the procedure chosen depends on the stage of the cancer and the patient’s health and preferences.
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Surgery for mesothelioma may be curative; for instance, the extensive extrapleural pneumonectomy removes a significant amount of tissue and may lead to remission. For later stages, surgical procedures are generally palliative, helping patients be more comfortable.[2]
Most mesothelioma patients are somewhere between the two extremes.A surgery, such as a lobectomy, may be used to remove as much malignant tissueas possible in order to extend life expectancy and reduce symptoms.
What Is a Lobectomy?
There are many different surgical procedures that can be used to 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 lobectomy is done 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. In some cases, the surgery may be less invasive; VATS, or video-assisted thoracoscopic surgery involves smaller incisions and tools.[3]
Lobectomy Treatment for Pleural Mesothelioma
Pleurectomy/decortication is a surgical treatment for mesothelioma that involves removing the pleural tissue, followed by any tissue with the tumors. The goal is to remove as much of the tumors as possible for slowing cancerous growth and to extend life expectancy of the patient. During this procedure, a surgeon may choose to do a lobectomy to remove the maximum amount of malignant tissue.[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 with the intention of curing 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.[5]
Mesothelioma that is so localized and can be cured by a lobectomy is extremely rare and rarely reported. In most cases a lobectomy is not a curative procedure. It can be a part of more extensive surgery with curative intent or to slow the progression of disease.
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 up 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 whenmaking a decision about lobectomy or any surgical procedure. Use your medicalteam’s guidance to make the best choice. For many mesothelioma patients, therisks are worth the potential benefits, especially because treatment optionsare limited.
Recovering from Surgery
If you are undergoing a VATS lobectomy for mesothelioma, recovery time will be less than if the surgery is more invasive. A stay of up to ten days in the hospital may be necessary for a safer recovery and to minimize or manage potential complications.
At home you will need to keep the incision sites clean and dry and monitor for signs of complications. 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 but removing less tissue than in more extensive surgeries can slow the progression of the disease and minimize risks and complications. Talk to your medical team if you have questions about this procedure or if you wonder if it is right for you.