Dr. Robert Cameron Meso Myth Buster
- Myth #3 -
Mesothelioma Tumor in the Lung “Fissures” Cannot Be Removed Without Also Removing the Entire Lung
The lungs have two (left) and three (right) distinct “units” called lobes. These lobes are attached to the center of each lung by both blood vessels and airways in much the same way that grapes are held together by their stems. They also are separated from each other by breaks called fissures, which essentially are lung or “visceral” pleura extensions that cut like a knife deep into the lung tissue and separate the various lobes.
When mesothelioma develops, the tumor immediately supplants every square inch of pleura, including the pleura that constitutes the fissures. At a glance, one might surmise that the mesothelioma tumor has “invaded” deeply into the lung tissue itself. This assumption, however, is not correct. Simply put, the fissures are still part of the lung's outer surface – a surface that is merely folded. In almost all cases, the tumor remains contained within the pleural membranes.
As the majority of experienced thoracic surgeons know, mesothelioma tumor can be surgically stripped off most surfaces inside the chest cavity. Remarkably, a few insist that “invasion of the fissures” renders the tumor unresectable without removing the lobes (and entire lung), too. In my experience, having done hundreds of operations, the tumor indeed can be separated from the lung's surface, including the fissures.
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In fact, in my experience, the removal of the tumor in the fissures is perhaps the easiest part of a decortication operation (decortication means the removal of tumor from the lung's surface). This small portion of the procedure can be accomplished surprisingly quickly, safely, and with characteristically complete tumor removal. If it can reasonably be separated, in my view, it should be, leaving the lung in place.
Interestingly, surgeons who favor removal of the entire lung along with the mesothelioma tumor (extrapleural pnemonectomy or EPP) frequently cite the difficulty in removing tumor in the fissures as a major justification for this radical procedure. This is unfortunate. In my view, that opinion is based more on a personal bias than on true technical considerations.
Removing tumor from the fissures is both technically feasible and rational, as it enables the patient to keep an otherwise healthy lung where it belongs, in the chest breathing in oxygen.
Dr. Robert Cameron
January 27, 2011
| Myth #1: | A more radical operation obviously provides better results than a less radical surgical procedure January 3, 2011 |
| Myth #2: | A more radical operation that takes out the pericardium and diaphragm for bigger margins is a better operation. January 11, 2011 |
| Myth #4: | Talc Pleurodesis Prevents Surgeons from Performing a Pleurectomy Operation February 15, 2011 |
Interested in Learning More?
If you have been diagnosed with malignant pleural mesothelioma and would like to learn more about Dr. Cameron’s approach to treating the disease, you may contact his office at (310) 470-8980.
Dr. Cameron sees patients in consultation at his Los Angeles, California clinic located at:
10780 Santa Monica Boulevard
Suite 100
Los Angeles, California 90025-7613
If you are traveling from out of town and would like assistance with travel arrangements, contact the Pacific Meso Center at (310) 478-4678 or info@pacificmesocenter.org.