For many patients diagnosed with malignant pleural mesothelioma, surgical removal of the tumors is the best hope for extended survival and relief of painful symptoms. While there is no universally accepted surgical therapy for this rare and challenging disease, the complex procedures that are available are best performed by experienced thoracic surgical oncologists, who are increasingly applying innovative minimally invasive methods to deliver the best possible outcomes.
What is a Thoracic Surgical Oncologist?
Thoracic surgical oncologists are physicians who have specialized training focused on the surgical treatment and management of cancers affecting the thoracic cavity. This includes the lungs, chest wall, esophagus, and mediastinum. Thoracic surgeons employ a variety of open and minimally invasive surgical techniques to diagnose, stage, and treat malignant tumors within the thoracic region, including malignant pleural mesothelioma.[1]
Thoracic surgical oncology is a relatively new medical practice: Doctors have only been practicing it in its more modern form for about 100 years, and the procedures offered have changed dramatically with the advent of innovations in diagnostic tools and supporting therapies, as well as new surgical techniques and abilities. Where open surgery was once the standard approach, it has been improved upon by minimally invasive techniques, video-assisted procedures, and robotics. These advancements have had a significant benefit for patients.[2]
In addition to surgical expertise, today’s thoracic surgical oncologists possess strong working knowledge of the role of molecular profiling and genomic sequencing as part of their multidisciplinary approach to patient care. Thoracic surgical oncologists partner with medical oncologists and radiation oncologists in the treatment of patients, coordinating treatment plans that see chemotherapy being administered preoperatively to enhance the effectiveness of surgery.
There is hope that pre- and post-operative targeted therapies and immunotherapies will continue contributing to surgical success, allowing thoracic surgical oncologists to offer surgical resection in cases that were once deemed too advanced for surgical intervention.[2]
How Does a Doctor Become a Thoracic Surgical Oncologist?
Deciding to become a thoracic surgical oncologist represents a significant commitment of time and a real dedication to patient care. After spending four years building a foundation in the sciences during undergraduate school and another four years in medical school engaging in in-depth scientific coursework, laboratory time, and clinical practice, the thoracic surgical oncology candidate will move on to an internship followed by multiple residencies and fellowships. They will spend time focusing on internal medicine as well as subspecialties in oncology and thoracic oncology, as well as on surgical training.
Residencies can each take between one and three years to complete, and often include both research and patient care, while fellowship training can last between two and five years depending on the focus and facility where the doctor receives their training. This time is spent on patient care, research, and surgery. In all, thoracic surgical oncologists generally invest at least ten years after the completion of medical school in gaining the necessary skills and expertise to provide the best possible care to patients.
What Procedures Do Thoracic Surgical Oncologists Perform for Malignant Mesothelioma
Patients diagnosed with malignant pleural mesothelioma are assessed to determine whether their tumors are operable. Those with resectable mesothelioma are further evaluated by the thoracic surgical oncologist and the rest of the multidisciplinary team to assess which surgical approach is best advised based on the patient’s disease, condition, and other factors. The current options include:[3]
- Pleurectomy/decortication is a surgery in which the pleural lining is removed, along with as much other diseased tissue as possible.
- Extrapleural pneumonectomy is a surgery in which the thoracic surgical oncologist removes the lining of the lung as well as the affected lung, the diaphragm on that side of the body, and some of the lining around the heart.
Additionally, thoracic surgical oncologists may be involved in procedures early in the patient’s assessment that aim at confirmation of the diagnosis of malignant pleural mesothelioma as well as procedures throughout the course of treatment focusing on relief of symptoms, especially for patients whose tumors are deemed inoperable. These procedures include:[4]
- Video-assisted thoracoscopy is a minimally invasive thoracic surgery performed using a small video camera mounted to a fiberoptic thoracoscope. It allows the surgeon to see inside the chest by viewing the video images relayed onto a television screen.
- Open biopsy is a procedure in which an incision is made through the skin to expose and remove tissues to check for signs of malignancy.
- Mediastinoscopy is a procedure in which an incision is made at the top of the breastbone and a thin, tube-like instrument with a light and lens for viewing is inserted to allow a view of the organs, tissues, and lymph nodes between the lungs.
- Pleurodesis is a procedure in which fluid is drained from the pleural space and then chemicals or drugs are used to create a scar between the layers of the pleura to stop the build-up of fluid in the pleural cavity.
Thoracic Surgical Oncologists Are Key to the Management of Pleural Mesothelioma
Because surgery plays such a central role in the diagnosis, staging, and management of malignant pleural mesothelioma, thoracic surgical oncologists are integral parts of the multidisciplinary team. They assist in achieving an accurate diagnosis, identifying the specific histologic subtype, and appropriate course of treatment as well as in accomplishing macroscopic complete resection of visible disease and the alleviation of symptoms.
