How will I feel after my surgery for pleural mesothelioma? How likely is it that there will there be complications?

It all depends on the surgery. Both EPP and pleurectomy are very serious and complicated procedures. However, surgeons who specialize in doing these procedures have learned to make them much safer, between selection of patients and meticulous technique that gets the surgery done as quickly as possible. Both procedures require a large incision in the chest. In EPP, one lung is removed plus all the pleura on that side of the chest. Artificial patches need to be put in place over the heart and diaphragm where the pleura has been removed. For a pleurectomy/decortication, the pleura on one side of the chest is removed, to get rid of the cancer and also free up the lung.

When you wake up after surgery, you will have drains, which are tubes coming out of your chest to remove any fluid or air that accumulates. You will probably have a tube coming out of your bladder, so that the doctors can monitor your output of urine, making sure you have enough fluids and that your kidneys are working. You will need oxygen especially if you have had a lung removed. Pain control is usually achieved with epidural anesthesia. That means a thin catheter has been placed going into the layers around your spinal cord and delivering medication, which can completely relieve your pain. As many as 60% of patients experience one complication or another after an EPP. There are many less complications with pleurectomy. Your surgeon will do everything to minimize complications, and treat them if they occur. This includes adequate pain control so you can be up and around, which lowers the risk of many complications. While this procedure offers a chance for better long-term survival, even in the best of hands, between 3 and 7% of patients die from complications after an EPP.

General complications from any serious surgery include infection at the surgical site, bleeding from the area, pneumonia, blood clots in the legs, urinary tract infection, and generalized infection (sepsis), among others.

With a pleurectomy, there will be many chest tubes in place to drain any liquid or air. These will remain in place for as long as 10 days. They are removed more quickly with an EPP. The complications of a pleurectomy, aside from those common to all surgeries, include infection inside the chest, and hemorrhage inside the chest. Both of these require surgery to correct.

With an EPP, a very dangerous complication happens if the tube which led to the removed lung, which has been closed off surgically, reopens. This requires surgery to repair. The most unusual complication has to do with the fact that the linings outside the heart have been removed, so the heart has been handled during surgery. That can lead to an irregular heartbeat, also known as an arrhythmia. This is treated with medication at the time it occurs and for about a month after surgery. After an EPP, patients can have a blood clot travel to the remaining lung, which is more dangerous since there is only one lung. They can also have heart attacks.

Other complications have to do with infections or openings in reconstructed areas such as the diaphragm.

For the first few days, the epidural or other significant pain control medication will allow you take deep breaths, get up and move around. This will help you recover more quickly. Eventually you will be getting pain medicine by mouth. You will be more comfortable breathing. Various tubes and drains will be removed.

You may stay in the hospital between a week and two weeks, unless you have had a major complication. You will not really feel recovered for six to eight weeks after such major procedures. Hopefully, once you are healing, the pain from your tumor will be decreased and your breathing will be easier.