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Thoracotomy is a term used to describe a surgical procedure that gives a surgeon access to the organs of the thoracic region: the lungs, heart, esophagus, and others. It involves an incision that cuts into the pleural space of the chest cavity and it is a major and invasive incision used for major surgeries, including those used to treat pleural and pericardial mesothelioma.
For patients with mesothelioma, a thoracotomy may be used to perform an extrapleural pneumonectomy, a pneumonectomy, a pleurectomy/decortication, or a pericardiectomy, all procedures that involve major surgery in an attempt to achieve remission or more realistically, to slow the progression of the cancer and give the patient a longer life expectancy.
Diagnosis vs. Treatment
Because a thoracotomy is so invasive, it is not used for diagnosing mesothelioma unless it is absolutely necessary. The preferred method for making a diagnosis is to perform a biopsy, which involves a much smaller incision and allows the doctor to simply remove a small piece of tissue. This does not require the big incision of a thoracotomy, but in some cases may not be enough for the doctor to access the tissue in question. If a biopsy cannot get to the tissue that needs to be examined, a surgeon may need to perform a thoracotomy.
Mesothelioma Surgeries and Thoracotomy
A thoracotomy can be used for any type of surgery on the thoracic region of the body. Several procedures used to treat mesothelioma rely on thoracotomy. The most radical and extensive surgery that is conducted with a thoracotomy is an extrapleural pneumonectomy. This is a surgery that gives an early-stage patient the best chance of remission and involves removing an entire lung, the pleura, lymph nodes, and part of the diaphragm.
Less radical is the pleurectomy/decortication surgery, or P/D. It involves only removing the tissue from the lungs and pleura that contains tumors, but it is still invasive and requires a thoracotomy. Surgeries used to treat asbestos-related lung cancer or mesothelioma that remove sections of the lung, such as a wedge resection or lobectomy, also require a thoracotomy.
How Patients Prepare
Undergoing a thoracotomy means going under general anesthesia and having major surgery. Patients must prepare properly for the procedure. If you are going to have a thoracotomy, your doctor or surgeon will tell you what to do to prepare. You may need to avoid certain medications, for instance, and if you smoke, you will probably be asked to stop for several weeks. Being prepared for major surgery also means being informed. Be sure to ask all the questions you have and get satisfactory answers so that you feel as comfortable as possible going into surgery.
A thoracotomy is an involved procedure and is major surgery. You may need to have imaging scans taken of your chest cavity and undergo some medical tests before going ahead with it. Before going under anesthesia, the medical team will situate you on your side with your arm up. The thoracotomy incision is made along the side of your rib cage and may be between four and ten inches long.
Once the incision is made the surgeon will spread apart the muscle and the chest wall to get access to your lungs, the pleura, lymph nodes, and the heart. Once this is done the surgeon can perform the surgery that will be used to treat your mesothelioma. When finished, the incision will be closed with stitches. You will also probably have chest tubes put in place that will help drain fluids from the chest cavity as you recover from surgery. The entire procedure typically takes several hours.
Because a thoracotomy is major surgery with general anesthesia and there are potential complications, patients must recover in the hospital for several days or up to two weeks. Recovery time is dependent on how extensive the type of surgery done with the thoracotomy is. For example, patients undergoing an extrapleural pneumonectomy will require more recovery time than those having just a section of the lung removed.
Recovery will be painful and slow. Patients have fluid drained from the chest cavity to prevent fluid buildup and infections and receive pain medications. Patients can expect to experience side effects from the surgery, which may include shortness of breath, pain, or numbness and burning around the incision site. Recovery in the hospital is important because patients may experience more serious complications and must be monitored for them and treated accordingly.
Patients can expect to require several weeks to recover fully and may experience shortness of breath and limited activity in the meantime, even after coming home from the hospital. During this time a patient may see signs of complications that require medical attention: a fever, redness, swelling, or oozing at the incision site, heart palpitations, swelling in the legs, nausea and vomiting, severe shortness of breath or chest pains, constipation, and a cough with mucous or blood.
Risks and Complications
There are many potential risks and complications that can occur during or after a thoracotomy. This is major, invasive surgery and the general possible complications include a bad reaction to anesthesia, blood clots, excessive bleeding, infections, and errors made during surgery that injure or damage other organs.
More specific to a thoracotomy, a patient may experience a lot of pain from this surgery or a buildup of gas or air in the chest cavity. Having comorbid conditions, especially diabetes, high blood pressure, heart disease, or kidney failure, may increase the risk of complications. Some of these may even make a patient ineligible for the surgery because the risks of complications are elevated.
Undergoing a thoracotomy is risky and serious, but it may be necessary if you are living with mesothelioma. This procedure may be the best chance of treating the cancer to provide you with an extended life expectancy. Not all patients with mesothelioma are eligible for surgery, so if you are, make sure you know what the risks are compared to the potential benefits and understand everything that is involved. Major surgery can be frightening, but it can also be the best way to treat your cancer.
Page Edited by Patient Advocate Dave Foster
Dave has been a mesothelioma Patient Advocate for over 10 years. He consistently attends all major national and international mesothelioma meetings. In doing so, he is able to stay on top of the latest treatments, clinical trials, and research results. He also personally meets with mesothelioma patients and their families and connects them with the best medical specialists and legal representatives available.