Extrapleural Pneumonectomy

Overview and Facts about Extrapleural Pneumonectomy

Extrapleural pneumonectomy is a type of thoracic surgery used to treat malignant mesothelioma (a cancerous tumor in the lining of the lungs).

It is a complete resection to remove an entire diseased lung and pleura, performed to remove unhealthy or cancerous tissue and prevent the spread of cancerous cells to other parts of the body.

In this procedure, your surgeon will remove your affected lung, part of your parietal pleura (the lining of the chest), part of your diaphragm (the muscle separating the belly and the lung), some of the lymph nodes and part of the pericardium (the membrane around the heart). These structures will be reconstructed using mesh fiber.

It is a major surgery that carries higher risks than lesser surgeries such as a lobectomy or wedge removal, in which only a portion of the affected lung is removed.

You will need to be in overall good health to have this procedure performed. If your heart and lung function are not good, your doctor may recommend another treatment.

What to Expect with an Extrapleural Pneumonectomy

During extrapleural pneumonectomy, you will be placed under general anesthesia.

Next, your surgeon will cut open the front of your chest (a sternotomy) or the side of your chest (a thoracotomy). This large incision gives the surgeon enough room to see the tumor in your lung and cut away all the diseased tissue.

Following the procedure, a temporary drainage tube will be placed to draw air, fluid and blood out of the surgical cavity before the incision is closed. You will stay in the hospital for 5-10 days and full recovery may take up to 6-8 weeks.

What are the Side Effects of an Extrapleural Pneumonectomy?

Since extrapleural pneumonectomy is major surgery, the main side effects you’ll experience are during the recovery process.

The incision site will be sore for several days. You may also experience soreness in your chest but pain medication will be enough to relieve any discomfort.

Make sure to ask your doctor about recommended medication as some over-the-counter drugs (such as aspirin) may increase bleeding. You will need to make sure to cough frequently to rid your lungs of accumulated secretions and walk often to avoid the formation of blood clots.

As your body heals, it may be harder to breathe, and you may get winded easier than usual. This is because you now only have one lung, so it has to work twice as hard to ensure your body gets enough oxygen.

What are the Risks of an Extrapleural Pneumonectomy?

There are many risks involved with having an extrapleural pneumonectomy. Some complications include an irregular heartbeat or cardiac herniation (when the heart moves out of its usual position).

Developing a bronchopleural fistula (a passage between the airway in the lungs and the lining of the lungs) is also possible, and this will cause coughing and shortness of breath.

Other major risks include:

• Blood clots
• Internal bleeding
• Lung infection
• Pneumonia
• Prolonged need for a respirator
• Pulmonary embolism (blockage of one or more arteries of the lung)
• Pulmonary edema (accumulation of fluid in the lung)

Your health care team and doctor will continue to monitor you for these complications to keep you safe during recovery.