Mesothelioma Surgery

Your doctor may recommend surgery once your diagnosis of mesothelioma has been confirmed. Whether you are a candidate for mesothelioma surgery will depend on a number of factors including your general state of health and the extent of your disease.

Generally speaking, there are two kinds of surgery for mesothelioma: curative and palliative. So what are the differences?

Mesothelioma surgery performed to extend a patient’s life is called curative surgery. However, it is important to remember that cancer cells can hide in the body after surgery and trigger a recurrence of mesothelioma. Curative surgery usually results in a period of cancer remission rather than an actual cure. Some patients who undergo this surgery have had long remissions.

When curative surgery is not an option for reasons of health or the spread of the disease, palliative surgery is used to temporarily relieve symptoms of mesothelioma and improve a patient’s quality of life.

Mesothelioma Surgical Options: Curative

If the cancer is caught in the early stages – while it is still isolated in one area of the body and has not metastasized – curative surgery has the potential to increase a patient’s life.  Such surgery is most likely to yield a better long-term prognosis if your cancer is Stage 1 or Stage 2.

If this is the case, your mesothelioma specialist will assess your condition, discuss with your treatment goals, and make a determination about which surgical procedure or procedures make the most sense for you. Curative surgery procedures include:

  • Extrapleural pneumonectomy (EPP)
  • Pleurectomy/decortications
  • Lobectomy
  • Thoracotomy

Extrapleural Pneumonectomy

During this procedure, a surgeon removes the lining of the chest wall, pericardium, diaphragm, and the entire lung on the side of the body where the tumor is present. Surgeons then reconstruct the pericardium and the diaphragm using prosthetic material. Because of the nature of the surgery, it is only performed if the doctor believes a cure is possible. Patients receiving this surgery must have localized epithelial mesothelioma and have good health. Only doctors who specialize in this surgery can perform it so patients often have to travel to a major medical center for this procedure.

Pleurectomy

A pleurectomy is a surgery involving the complete decortification of the lung and parietal pleura. This surgery involves a complete resection of both the parietal and visceral pleura. In addition, a pericardial, diaphragmatic or additional lung nodule resection may be involved.

As well as those suffering from malignant pleural mesothelioma, patients with a pleural effusion or trauma might undergo this as a palliative procedure. Typically thoracic or cardiothoracic surgeons perform the surgery, which requires a general anesthesia, putting the patient completely asleep during the procedure.

Pleurectomy is an invasive surgery involving an incision above the diseased area and the removal of the affected pleura and tissues. Chemotherapy or radiation might also be used to treat malignant mesothelioma patients.  While pleurocentesis is often used to reduce fluid buildup and provide pain relief, a pleurectomy is sometimes recommended to more aggressively treat this condition.

Although a more involved procedure, a pleurectomy can provide the comfort patients suffering from pleural effusion seek. Patients undergo a post-operative interview following the procedure, where the doctor will recommend steps to aid healing, including deep breathing exercises and frequent bandage changes.  Typically, patients employed in sedentary professions will be allowed to return to work after a couple of weeks.

Lobectomy

A lobectomy for malignant mesothelioma treatment involves the surgical excision, or removal, of a patient’s lung. Performed on those in the early stages of pleural mesothelioma, this procedure is not performed on patients with metastasized cancers.

Because of its high level of invasiveness, this surgery is only performed on healthy patients that doctors feel can withstand the stress of the procedure and the subsequent recovery process. A lobectomy is performed during a thoracotomy, where an incision in the chest and rib removal or spreading allows the surgeon access to the lung.

After the incision is made and doctors have access to the affected lung, the main arteries, air tubes and veins receive clamps before being severed. Free of any connecting tissue, the lobe is then removed. A drainage tube insertion follows, ending with the closing of the surgical wound. The drainage tube prevents lung collapse or the post-operative buildup of fluids.

Requiring general anesthesia, this surgery is recognized as among the most difficult based on the difficult recovery process, which includes high levels of pain. As a result of this pain, patients may not breathe deeply, leading to further complications like atelectasis, a lack of gas exchange within the alveoli, or pneumonia.

Thoracotomy

Thoracotomy is performed to access the lungs, heart, trachea or diaphragm. It may be undertaken to confirm a mesothelioma diagnosis or to remove cancerous areas.  It is performed by making a cut in the side of the chest between the ribs. The ribs are then spread apart to allow the surgeon to see inside the chest cavity. In cases of mesothelioma, the surgery avoids the areas of the chest that contain the heart and spinal cord. Pneumonectomy is a type of thoracotomy surgery in which an entire lung is removed.

A thoracotomy requires a chest tube to drain any excess fluid buildup after surgery and recovery time can be as long as three months.

Mesothelioma Surgical Options: Palliative Surgery

Mesothelioma has long latency period and can be difficult to diagnose. For these reasons, the cancer has usually spread within the body by the time a diagnosis is confirmed. Once a patient’s mesothelioma has metastasized and is considered to be at Stage 3 or Stage 4, it is no longer possible to pursue curative surgery.

Your doctor may now recommend that you consider undergoing palliative surgery. The idea behind all palliative surgical procedures is to make the patient more comfortable and improve their quality of life while they battle their disease. Such surgery will not cure mesothelioma but it can help to ease the discomfort and pain caused by tumors. The typical surgical options include:

  • Paracentesis
  • Pleurodesis
  • Thoracentesis
Some curative surgeries such as a pleurectomy may also be used for palliative purposes.

Paracentesis

In this procedure, a doctor inserts a long and thin needle into the abdomen to remove fluid from the body. Paracentesis is both a diagnostic and a treatment tool. It can be used to treat ascites, a painful fluid buildup in the abdominal cavity. When done in the chest cavity, it is known as thoracentesis.

Pleurodesis

This procedure involves talc or other chemicals that are injected into the chest cavity to prevent the recurrence of fluid buildup. This procedure has a 90% success rate for patients with mesothelioma. Although the procedure is deemed successful, it is only a temporary measure. Since anesthesia is used as part of this procedure, it is done in a hospital.

Thoracentesis

This procedure involves the removal of fluid that has built up around the lining of the lungs. The fluid causes chest pain and shortness of breath, so the removal process relieves these symptoms. This procedure is the most commonly performed for mesothelioma and it can be done as an outpatient procedure. If a patient is suffering from mesothelioma of the heart or abdomen, a similar surgery can be performed to drain fluid from these areas.

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