Decortication of Trapped Lung (Corrected Title) - 1253586

linkslady
Posts:2

I have a trapped lung which has been diagnosed as caused by pleural effusion containing malignant cells consistent with serous carcinoma. I have a history of ovarian cancer, stage IIIc.Am currently receiving chemo treatments of avastin/topotecan Sorry for using your site, although I don’t have lung cancer, my questions involve the lung.

My thoracic surgeon has suggested that the only possibility for re-expanding the lung is a thoracotomy with decortication but that it is rarely successful when malignant disease is involved. My only other option is to live with the collapsed lung and the resulting shortness of breath. My questions:

1. How would I go about finding a thoracic surgeion who specializes in trapped lung/decortication for a second opinion?

2. Are there treatments other than a thoracotomy–a major surgery with not great results which would require that I stop chemo treatments in order to have the surgery?

3. Is there a reason that the decortication is more difficult and less successful when malignant disease is involved than in other decortications? How is the rind different?

Thank you for whatever assistance you can provide.

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Reply # - February 8, 2013, 09:43 AM

catdander
Posts:

Hello linkslady, I'm very sorry you've had to seek out this help. I can only imagine how horrible this all is.
You're right we don't usually answer questions about ovarian cancer. However we do have a thoracic surgeon on faculty that may be able to help with your questions.
I will asked for his input though since he is our only resource on thoracotomies it may take a day or so for a response.

I had to look up the term docortification. It isn't a procedure I remember being discussed on Grace before and it didn't come up on a search of the Grace site.

Just one more thing and I think you're already on that track is find a "dedicated" thoracic surgeon who does this procedure more often that others. Experience and good results are essential.

I hope you do well,
Janine
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Reply # - February 8, 2013, 10:04 AM

catdander
Posts:

FYI, we may be out of luck in getting Dr. Farivar, our thoracic surgeon to comment. It seems he's out of the office until the 19th and only checking emails sporadically. However I'll make sure Dr. West or Weiss adds input. Their thoughts are always well worth having.

Reply # - February 8, 2013, 10:17 AM

certain spring
Posts: 762

I think it might be "decortication", as explained here:
http://www.cts.usc.edu/zglossary-decortication.html
Linkslady, I'm sorry for the situation in which you find yourself, and I hope the lung isn't giving you too much trouble at the moment. I think you are wise to ask if there are other options than surgery. Pleural effusions are sometimes drained, or there is a procedure called pleurodesis which soaks up the fluid with talc. Such procedures could help with breathlessness and pain.
I also wonder if the whole lung is "trapped", as you put it, or whether it is just one lobe? I have a wholly collapsed left lower lobe and it is not as bad as it sounds. Very best.

Reply # - February 8, 2013, 10:45 AM

catdander
Posts:

I did notice the 2 different terms. decortication does seem to be the favored one. detective cs :wink:

"decortication, decortification
1. removal of the outer covering from a plant, seed or root.
2. removal of portions of the cortical substance of a structure or organ."
from, http://medical-dictionary.thefreedictionary.com/decortification

I wondered if other options were available too, I can't find it now, odd, but there's a website dedicated to decorti...cation and it has a page dedicated to pleurodesis. It made me wonder if that may be an option. I also notice that some decortications are done via VATS, a thoracotomy using scopes instead of full open surgery.

Reply # - February 8, 2013, 12:38 PM

double trouble
Posts: 573

Dear linkslady,

I too am saddened by your circumstance. If you are in the U.S. and can get there, I highly recommend Dr. Thomas D' Amico and the team at Duke University Hospital in Durham , North Carolina. And even if you can't get there it might be worth a call to see if a long distance consult is possible.

http://www.ncbi.nlm.nih.gov/pubmed/20103240

http://www.dukehealth.org/physicians/thomas_a_damico

Best of luck to you in this difficult situation.
Debra

Reply # - February 8, 2013, 05:35 PM

Dr West
Posts: 4735

I don't believe that there are thoracic surgeons who are that specialized. Finding a board-certified thoracic surgeon, as opposed to a general surgeon or cardiothoracic surgeon who does lung surgery intermittently between cardiac cases, is likely to provide nearly as specialized an expertise as you'll be able to find. If you happened to search for a lung surgeon who does a lot of work on mesothelioma, that might provide the very best chance for the kind of expertise you need, since mesothelioma is a cancer of the lining of the lung, which is quite similar to the situation you're facing.

Here are a couple of links that can potentially help you understand the options:

http://cancergrace.org/lung/2007/03/17/intro-to-pleural-effusions/

http://cancergrace.org/lung/2007/03/18/mpe-managment-options/

As for why it's more difficult with a cancer, the pleural lining is supposed to be a very, smooth, thin, lubricated onion skin. When it's cancerous, it's more like the rind of an orange, though it may also invade into and stick to the surfaces of the chest wall and/or lung, making it a harder process to remove that lining.

I'm sorry I can't offer more insight. This is really more within the realm of what a thoracic surgeon does, and I'm afraid that Dr. Farivar, a very good thoracic surgeon and great communicator, is out of town and currently not available.

Good luck.

-Dr. West

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