The extrapleural pneumonectomy is a radical surgery. It is done to remove the tumor and tissue to which it might have spread in order to prepare the chest for radiation therapy. IMRT or intensity modulated radiation therapy is an advanced form of radiation therapy in which multiple small beams of radiation are used to irradiate the target area. The beams are shaped and angled in order to focus the radiation on the targeted area while reducing the radiation exposure of other tissue. The combination of the operation and the IMRT provide good local control of the residual cancer. That is, the tumor is unlikely to reoccur in the areas that have been irradiated; however, if frequently arises elsewhere.
The operation begins with an incision in the back that cures around to the front. I believe it follows the line of the sixth rib because the first step after the incision is to remove the rib in order to provide better access to the chest cavity after the incision is spread wider and clamped open.
There are three major components of the surgery, and I do not know the order in which they are performed.
1. The diaphragm is removed and a patch made of medical Gore-Tex is sewn in its place.
2. The pericardium, the sack around the heart, on that side is removed and replaced by an absorbable mesh which will be replaced by scar tissue. This will keep the heart from shifting to the right into the chest cavity.
3. The lung is removed and the right main bronchus, the tube that brings air into the right lung, will be closed and sealed. A leak test is done to ensure that the seal is complete because it is essential that no air enter the chest cavity.
Then I will be closed up.
Over time the chest cavity will fill with fluid, and the surgeon said that when I move suddenly I might hear a sloshing sound as it fills. The fluid would provide a great culture medium should the bronchus leak and allow bacteria to get in.
Recovery will be long and painful. This surgery is more painful than bypass surgery because of the spreading of the ribs. Nerves can be damaged resulting in chronic pain. I'm not looking forward to the surgery or the recovery.
David
