Posts Tagged ‘extrapleural pneumonectomy’
For Mesothelioma survivors like Heather Von St. James who have undergone an extrapleural pneumonctomy as treatment for their pleural mesothelioma, one day a year has a unique designation. Feb. 2 is St. James’ Lung Leavin’ Day. The name graphically illustrates the basic tenant of the medical procedure, which involves removing a lung and some of the tissues and diaphragm surrounding it in order to remove the cancer that affects the lining of the lung and chest cavity.
Now, thanks to a new Italian medical discovery, an innovative new surgical technique could reduce surgery complications and increase the number of survivors with their own Lung Leavin’ Days in the future. (more…)
It might sound crazy to some people, but mesothelioma survivor Heather Von St. James, her family, friends and ever-growing network of meso warriors are getting ready to celebrate the 8th annual Lung Leavin’ Day on Februrary 2, 2014. The celebration was devised to mark the anniversary of Heather’s extrapleural pneumonectomy – a radical treatment for mesothelioma in which a lung, part of the diaphragm and surrounding tissue is removed in an effort to battle the rare cancer caused by asbestos exposure. (more…)
A new case study has revealed a possible connection between an aggressive treatment for mesothelioma and the risk of heart failure resulting from tension hydrothorax. Published by the National Center for Biotechnology Information (NCBI) in its Heart Surgery Forum, the case involves a mesothelioma patient who underwent an extrapleural pneumonectomy (EPP). (more…)
Those of you who have been following the myMeso blog for a while remember our friend Heather Von St. James, a meso survivor and warrior from Minnesota. Heather was diagnosed with malignant pleural mesothelioma just a few months after giving birth to her daughter Lily, at the young age of 36. There is currently no known cure for mesothelioma, which is related ot asbestos exposure, and traditionally patients are given a matter of months to live following a diagnosis. This was unacceptable to Heather and her husband, Cameron, were determined to find an answer, and to fight. (more…)
The results of a study published recently in The Journal of Thoracic and Cardiovascular Surgery supports the use of extrapleural pneumonectomy-based multimodal therapy in carefully selected patients with malignant pleural mesothelioma. The Journal is published by The American Association for Thoracic Surgery.
According to the research summary, the objective of the study was to evaluate the perioperative and long-term outcomes associated with extrapleural pneumonectomy for patients with malignant pleural mesothelioma. Pleural mesothelioma affects the lining of the chest cavity and lungs. Other forms of mesothelioma include pericardial, which affects the lining of the heart and is extremely rare; and peritoneal, which affects the lining of the abdomen. Mesothelioma is atributed almost exclusively to asbestos exposure.
According to the Multimedia Manual of Cardiothoracic Surgery, extrapleural pneumonectomy was introduced in the 1940s for the treatment of extensive infections of the lung and pleural space. Over the past 20 years, the extrapleural pneumonectomy technique has been modified and applied to the treatment of locally advanced malignant pleural mesothelioma, achieving substantial reductions in mortality. The surgery involves the removal of the lung with visceral and parietal pleurae, pericardium and diaphragm.
Researchers selected 70 patients between October 1994 and April 2008 to undergo the procedure. Prognostic factors included age, gender, side of disease, asbestos exposure, histology, positron emission tomography, date of surgery, neoadjuvant chemotherapy, completeness of cytoreduction, lymph node involvement, peioperative morbidity, adjuvant radiotherapy and pemetrexed-based chemotherapy.
The mean age of patients was 55 years. The median survival was 20 months, with a 3-year survival of 30 percent. Analyses showed improved survival for patients with asbestos exposure, negative lymph node involvement, and receipt of adjuvant radiation or postoperative pemetrexed-based chemotherapy.
The study was conducted by physicians from the University of Sydney, Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital; The Baird Institute for Applied Heart and Lung Surgical; Department of Medical Oncology, Sydney Cancer Center, Royal Prince Alfred Hospital; and Department of Radiation Oncology, Sydney Cancer Center, Royal Prince Alfred Hospital; all in Sydney, Australia.
When Charlene Kaforey, 48, was diagnosed with pleural mesothelioma in July 2007, she immediately began seeking out information and treatment options.
The prognosis for mesothelioma is still bleak. There is no cure, and most studies estimate survival time between 4-12 months, depending on the stage of presentation. Charlene’s mesothelioma was diagnosed relatively early, so she was hopeful.
She visited mesothelioma specialist Dr. David J. Sugarbaker at Brigham & Women’s Hospital in Boston, Mass., Dr. Valerie W. Rusch at Memorial Sloan Kettering Cancer Center in New York, and Dr. Harvey Pass at the NYU Cancer Institute.
Immediately, doctors talked about extrapleural pneumonectomy, a surgery to remove the entire lung, entire diaphragm, and the lining of the chest cavity and the heart. Surgery would be followed by 6 weeks of radiation, and possibly chemotherapy. One doctor even talked about performing a heated chemotherapy wash of the chest cavity while on the operating table. At that time, they believed Charlene was a stage I, and such surgeries could give her a 40 percent chance of a 5 year survival. One doctor mentioned getting her as much as 10 years.
One of the doctors talked about limiting the surgery to a pleurectomy/decortication, a technique to remove the parietal pleura from the lung. The median survival after pleurectomy for malignant mesothelioma ranges from 6-21 months, and 9-40 percent of patients survive up to 2 years. However in later stages, the survival rates are almost identical between the two surgeries.
Research is still unclear as to whether extra-pleural pneumonectomy provides significantly greater benefits than pleurectomy, and if either is significantly more effective than non-surgical options.
Charlene didn’t have a lot of tumor bulk, so she was sent for a mediastinoscopy, a biopsy surgery that allows doctors to view the middle of the chest cavity and to remove lymph nodes from between the lungs to test them for cancer or infection. They found that Charlene did have lymph node involvement.
“I went from a Stage I to Stage III overnight,” she says. “It was shocking.”
Because of the lymph node involvement, doctors recommended she postpone considering pleurectomy or pneumonectomy and undergo chemotherapy. Survival rates from either surgery for a Stage III patient is much less, and only 25 percent survive 20 months, with less than 10 percent surviving 5 years. Both surgeries involve significant mortality rates and require 6-9 months recovery time.
“Looking at it now, I feel in some ways that having the lymph node involvement was a godsend for me,” Charlene says. “I mean, my condition was more serious, but because I was doing the chemotherapy, it gave me time to look for more information and to really think more about my options. Otherwise, I would have rushed into a very serious surgery with a long, difficult recovery and I’d probably be without a lung and diaphragm right now.”
Charlene offers one word of caution to meso patients.
“While you may feel time is of the essence, don’t rush into a procedure until you really understand what is involved, and what benefits you can expect to receive, what the risks and complications are, how long and difficult the recovery will be,”she said.
She talked to other meso patients and read everything she could get her hands on. Quality of remaining life is a big issue to consider.
“I realized that I might have only 18 to 30 months maximum to live, and that I would spend at least 9 months in a brutal recovery. I was feeling good with little to no symptoms. I couldn’t justify giving up my good health to surgery, knowing I may never feel good again, and might have only another 9 months of poor quality life after recovering from the surgery,” Charlene says.
Next: Charlene explores alternative medicine