Extrapleural pneumonectomy is a type of surgery performed to treat pleural mesothelioma , a type of cancer that affects the organs of the chest. This procedure is referred to as an open surgery because the physician will make a fairly large incision, roughly nine to 10 inches, using an instrument called a scalpel. The affected lung, part of the diaphragm, and the tissue surrounding the heart are then carefully cut out in an effort to remove as much of the cancer as possible. This procedure is only performed on patients who have been diagnosed with early-stage mesothelioma which has not spread to surrounding tissues or to the lymph nodes.

MedStar Washington Hospital Center is fully equipped to perform complex surgeries such as extrapleural pneumonectomy. Thoracic surgeons at MedStar are specialists in the diagnosis and treatment of pleural mesothelioma.

Why Extrapleural Pneumonectomy Is Performed

Mesothelioma is a type of cancer that affects certain cells, called mesothelial cells, that form the inner lining of certain organs of the body, like the lungs, the abdomen, and the tissue that surrounds and protects the heart. Mesothelial cells also form the protective lining around the internal organs.

The majority of cases of pleural mesothelioma develop as a result of exposure to asbestos. By surgically removing the affected lung and/or tissue, in addition to providing treatments such as radiation and/or chemotherapy, physicians are able to stop the spread of cancer. The two main goals of extrapleural pneumonectomy surgery are to control and inhibit the spread of cancer while improving the probability of survival.

What to Expect During a Extrapleural Pneumonectomy Procedure

During an extrapleural pneumonectomy procedure, the patient is placed under general anesthesia. The surgeon then makes an incision, approximately 10 inches long, at the front of the chest or on the side of the body. The chest cavity is opened, and the surgeon inspects the tissues of the chest cavity for visible signs of cancer and/or damage. The entire affected lung is removed in addition to other visibly cancerous tissues commonly affected by pleural mesothelioma, such as the tissue that lines the outside of the heart and the diaphragm. An extrapleural pneumonectomy surgery typically takes three hours to complete, and more if a complex approach is required.

Risks Associated with Extrapleural Pneumonectomy

Certain risks are associated with all surgical procedures. Since extrapleural pneumonectomy is considered a complex surgery, the risks can be more serious than with other procedures. The benefits of this surgery are significant. However, the risks must be taken into account. Risks associated with extrapleural pneumonectomy include:

  • Blood clot development
  • Empyema (a buildup of pus in the chest cavity due to infection)
  • Pneumonia
  • Hemorrhage or internal bleeding
  • Respiratory failure
  • Death

Additionally, there is a risk of cancer recurrence after surgery.

Benefits of Extrapleural Pneumonectomy

Although extrapleural pneumonectomy is a more risky procedure compared to a simple pneumonectomy (which only removes the affected lung and not surrounding tissues), it provides patients with significant benefits, which may include:

  • Significant decrease in or elimination of the risk for the spread/metastasis of pleural mesothelioma
  • Increased lifespan
  • Improved ability to breathe properly

Additionally, the procedure improves symptoms experienced from pleural mesothelioma, because the majority, and sometimes all, of the cancer is removed at the time of surgery.

How to Prepare for Extrapleural Pneumonectomy

In order to be considered a candidate for extrapleural pneumonectomy, patients must be in good health. For this reason, a battery of tests may be prescribed in order to evaluate the overall health of the patient. Some of the tests may include:

  • Echocardiogram (ECG): Allows physicians to see the structure of the heart and identify any abnormalities.
  • Pulmonary function test: Evaluates how well the lungs are working.
  • Blood tests: Detects signs of infection or decreased organ function that can affect an individual’s health.
  • Imaging studies: Provides images of the chest region.

Prior to surgery, the surgeon and caregivers will provide specific instructions to follow. It’s important to follow all instructions given by the surgeon in order to ensure a safe operation.

Post Extrapleural Pneumonectomy Treatment

Following extrapleural pneumonectomy, the patient is required to remain in the hospital, under the care of nurses and the surgeon, for up to two weeks. During this time, caregivers will monitor the health of the patient. Patients will also work with nurses and physical therapists to exercise the lungs using breathing exercises, as well as exercise the body with walking.

Recovery can take as long as 2 months or more, including the post-surgical hospital stay. Many patients undergoing extrapleural pneumonectomy surgery will be prescribed radiation or chemotherapy treatment after surgery.


Make an Appointment

For an appointment with a specialist, call 202-877-3627.