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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 extensive and radical 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 pleura and lungs that contains tumors, but it is still invasive and requires a thoracotomy. Surgeries used to treat mesothelioma or asbestos-related lung cancer that remove sections of the lung, such as a lobectomy or wedge resection, also require a thoracotomy.

How Patients Prepare

Undergoing a thoracotomy means having major surgery and going under general anesthesia. Patients must prepare properly for the procedure. If you are going to have a thoracotomy, your surgeon or doctor 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.

The Procedure

A thoracotomy is an involved procedure and is major surgery. You may need to undergo some medical tests and have imaging scans taken of your chest cavity 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 is likely to take several hours.

Recovery

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. The more extensive the type of surgery done with the thoracotomy, the longer the recovery time will be. 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 slow and painful. Patients receive pain medications and have fluid drained from the chest cavity to prevent fluid buildup and infections. 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.

Even after coming home from the hospital, patients can expect to require several weeks to recover fully and may experience shortness of breath and limited activity in the meantime. During this time a patient may see signs of complications that require medical attention: a fever, redness, swelling, or oozing at the incision site, severe shortness of breath or chest pains, heart palpitations, swelling in the legs, nausea and vomiting, constipation, and a cough with blood or mucous.

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, excessive bleeding, blood clots, 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 serious and risky, 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 understand everything that is involved and what the risks are compared to the potential benefits. Major surgery can be frightening, but it can also be the best way to treat your cancer.

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