Thoracotomy is a general term for a surgery that allows doctors to access a patient’s lungs, heart, aorta, trachea or diaphragm. The incision, typically between 4 and 10 inches in length, can be made on either side of the chest.

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While surgeons generally opt for a minimally invasive thoracoscopy to perform biopsies and remove small lung cancer tumors, more extensive procedures require a thoracotomy. Mesothelioma surgeons perform a thoracotomy before completing pleurectomy/decortication and extrapleural pneumonectomy, two leading surgical options for the management of pleural mesothelioma. This procedure is also the first step of several asbestos-related lung cancer surgeries, like pneumonectomy and lobectomy.

Even with the latest advances in imaging technology and other diagnostic techniques, up to 25 percent of mesothelioma patients cleared for surgery are found to be inoperable after a thoracotomy. If surgeons realize the planned surgery is not possible after directly viewing a patient’s lungs, they may use the opportunity to stage the extent of disease and guide the patient’s options for nonsurgical therapy.

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Surgeries that Require a Thoracotomy

Surgeons may perform this procedure in order to complete a variety of surgical therapies for mesothelioma or asbestos-related lung cancer. It provides surgeons direct access to the lungs in order to diagnose a cancer, determine its stage or remove visible tumors. Post-thoracotomy procedures may aim to alleviate bothersome symptoms, slow tumor progression or prolong survival.


Mesothelioma surgeons have long depended on pleurectomy/decortication to manage mesothelioma symptoms and extend patient survival. This two-part procedure involves removal of the lungs' pleural lining followed by removal of any visible signs of tumor growth.

Extrapleural Pneumonectomy

Extrapleural pneumonectomy is an aggressive mesothelioma surgery in which doctors remove an entire cancerous lung and sections of the parietal pleura (membrane lining the chest), pericardium (membrane lining the heart), and diaphragm (muscle used for breathing).

Wedge Resection

Wedge resection is a common lung cancer surgery in which doctors remove a small, wedge-shaped section of the lung that contains a small tumor. In addition to the tumor, surgeons remove some healthy tissue that surrounds it.


A segmentectomy, or segment resection, involves removal of a larger portion of the lung than a wedge resection, but not an entire lobe. The section of lung that doctors remove includes any veins, arteries and airways affected by the cancer.


A lobectomy involves the removal of a complete lobe of the lung that contains cancerous cells. If the cancer is confined to a single lobe, doctors can remove it without sacrificing the function of healthy lobes. The left lung is divided into two lobes, while the right lung contains three.


When a tumor is centrally located or invades multiple lobes of the lungs, surgeons may perform a pneumonectomy, which involves removal of the entire diseased lung. For tumors of this size or location, less invasive procedures like lobectomy are not possible. Not all patients have adequate lung function to undergo pneumonectomy, but many can maintain an active lifestyle after the procedure.

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Risks and Complications

Although a thoracotomy is a serious operation, it is typically safe. Before the procedure, your doctor will explain all the potential complications of the procedure, which may include:

  • Bleeding
  • Infection
  • Injury to organs in the chest
  • Adverse reaction to anesthesia
  • Air or gas buildup in the chest
  • Persistent pain

Although a thoracotomy is a serious operation, it is typically safe. Before the procedure, your doctor will explain all the potential complications of the procedure, which may include:

  • Bleeding
  • Infection
  • Injury to organs in the chest
  • Adverse reaction to anesthesia
  • Air or gas buildup in the chest
  • Persistent pain

Some other factors may increase the risk of complications for patients, including:

  • Diabetes
  • Hypertension
  • Kidney failure
  • Past stroke or heart attack
  • Other chronic medical conditions
  • History of heavy smoking
  • Major trauma affecting multiple body parts

Overview of the Procedure

Prior to surgery, your doctor will perform some tests to assess your overall health, which may include a physical exam, blood test or urine test. Your doctor will also need to perform tests to evaluate how well your heart and lungs function. One or more imaging scans will be required, such as a chest X-ray, CT scan or MRI.

You will meet with an anesthesiologist who will describe the medications you'll receive during the procedure. This doctor will answer any questions you have before administering general anesthesia.

At the start of the procedure, doctors position you on your side and elevate your arm. Next, the surgeon makes an incision, approximately 4 to 10 inches long, spanning from your upper back, under your arm, and to the side of your rib cage.

To access your lungs through the incision, the doctor must spread your muscles and ribs and open the chest wall. Once surgeons have access to your open chest, they can perform the appropriate procedure to treat your mesothelioma.

When this procedure is complete, a doctor will place one or more temporary chest tubes that allow air, blood and other fluids to drain from your chest as you heal. The surgeon will then close your chest wall and seal the incision using sutures or staples. The tubes remain in your chest for one to three days, perhaps longer if necessary. Most patients stay in ICU for two to three days before they are moved to a normal hospital room.


The average hospital stay after thoracotomy is five to 10 days. You will likely experience pain, numbness or burning below your breast and at the front of your rib cage — a result of irritation to nerve endings near the incision.

Drainage of a clear or pink fluid from the incision is normal. You should clean your incision in the shower, washing gently with warm water and a mild soap. Avoid submerging the incision in a bathtub or spa for three weeks.

Pain and a mild shortness of breath are common after this procedure, but several symptoms should be a cause for concern. Contact your doctor immediately if you experience any of the following:

  • Sudden, severe shortness of breath, chest pain or difficulty breathing
  • A fever higher than 100.5 degrees
  • Swollen extremities or leg pain
  • Heart palpitations
  • Increased redness or swelling of incisions
  • Foul-smelling drainage from incisions
  • Excessive bleeding from incisions
  • Bubbling or sucking sound coming from incisions
  • Severe nausea or vomiting
  • Coughing up yellow, green or bloody mucous
  • Constipation that persists after taking stool softeners

In the several weeks following your procedure, the pain and limitations to your range of motion will gradually subside. It is important that you avoid heavy lifting and other strenuous activities for six to eight weeks, as they could put stress on your incision and delay recovery. You should perform breathing exercises and walk every day to help improve your strength, circulation and lung capacity. Always follow your doctor's directions for home recovery, and follow up with him or her if you have questions.

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Karen Selby is a registered nurse and a Patient Advocate at The Mesothelioma Center. She worked in several subspecialties within nursing before joining in 2009.

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  5. University of Southern California. (n.d.). A Patient’s Guide to Lung Surgery: Anesthesia. Retrieved from
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  7. Roswell Park Cancer Institute. (n.d.). Understanding Thoracotomy. Retrieved from
  8. University of Southern California. (n.d.). A Patient’s Guide to Lung Surgery: Recovering at Home After a Thoracotomy. Retrieved from

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