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Surgery is one of the standard treatment options for patients with malignant mesothelioma. Typically performed in combination with radiation and/or chemotherapy, surgery can potentially cure mesothelioma or, depending on the cancer stage, prevent or relieve symptoms.

Curative vs. Palliative Surgery

SurgeryMesothelioma has a complex growth pattern that makes complete surgical removal a very difficult task, which is why surgery that aims to remove all cancer cells is more accurately described as “potentially curative” rather than “curative”. Part of what makes cancer such a stubborn malady is that it’s very difficult for surgeons to remove all cancer cells, and any cells that are left behind can grow, divide and lead to the cancer’s return. To try and prevent this from happening, the surgeon removes as much tissue as the patient can safely tolerate. More extreme surgeries attempt to remove visible cancerous tissue as well as tissue that is a likely site for metastasis. Not all patients are healthy enough for more invasive mesothelioma surgeries, however, and sometimes the cancer is too widespread to be removed completely. In these instances, “palliative surgery”—or surgery meant to ease cancer symptoms instead of potentially curing the cancer—may be performed. Palliative mesothelioma surgery can extend a patient’s life and improve their quality of life.

Multimodal Therapy

Whether surgery is performed for curative or palliative purposes, it is rarely performed in isolation. Surgery is almost always accompanied by the other standard treatments for mesothelioma: chemotherapy and radiation. Neoadjuvant therapy for mesothelioma is chemotherapy or radiation administered to a patient before surgery in order to shrink mesothelioma tumors and make their removal more manageable. Adjuvant therapy is chemotherapy or radiation administered post-surgery to help prevent the recurrence of tumors.

Pleural Mesothelioma Surgery

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Pluerectomy/Decortication

Pleurectomy/decortication (P/D) is a surgical procedure where the parietal pleura, the visceral pleura and possibly tissue from the chest wall, diaphragm and pericardium are all removed. The lung on the affected side, however, is left in place. This procedure is often referred to as lung-sparing surgery.

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Extrapleural Pneumonectomy

The alternative to P/D is the extrapleural pneumonectomy (EPP), which is a radical and complex surgery to remove the affected lung and parietal pleura and possibly remove the diaphragm, the pericardium and other extrapleural tissue. For patients in all but the earliest stages of the disease, an EPP is generally considered the best procedure to achieve a macroscopically-complete resection.

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Palliative

A number of palliative surgeries are available for pleural mesothelioma patients. A patient’s eligibility for a given procedure will be based on his or her overall health and performance status.

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Pleurodesis

Pleurodesis is a procedure that fuses together the parietal pleura and the visceral pleura, obliterating the space between them. It is the most commonly-performed palliative procedure and is done to prevent fluid build-up in the pleural space and the recurrence of pleural effusions.

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Debulking Pleurectomy

A debulking pleurectomy is a surgical procedure that attempts to remove as much of the cancer from the parietal pleura as possible. It reduces the dyspnea (shortness of breath) associated with heavy tumor burden and can be used in conjunction with pleurodesis to improve a patient’s quality of life.

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Decortication of the Lung

A decortication of the lung is a surgical procedure to remove the visceral pleura from the lung. It is performed when the lung is constricted and unable to fully expand due to tumor infiltration of the visceral pleura. It can also be used in conjunction with pleurodesis to improve a patient’s quality of life.

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Pleural Catheters and Pleuroperitoneal Shunts

Implanted pleural catheters and pleuroperitoneal shunts can offer effective palliation for patients who suffer from recurrent pleural effusions and other fluid buildups. Generally, these options are used over the long term only for patients with late stage disease who are not amenable to other treatment options.

Peritoneal Mesothelioma Surgery

Peritoneal mesothelioma surgery may be considered curative or palliative based on the stage of the disease. Not all patients are healthy enough for abdominal surgery, in particular the more invasive forms that involve removal of cancer from multiple abdominal sites.

Cytoreduction/Debulking

Cytoreductive surgery—alternately known as debulking—seeks to remove all visible cancer from the peritoneal cavity through multiple procedures in a single surgery. Mesothelioma tumors may be found on not only the peritoneum, but also on the omentum (a sheet of fat in the abdomen) and abdominal organs, including the spleen, pancreas, intestines, liver, colon, uterus, ovaries, stomach, bladder, and gallbladder. Typically, cytoreduction is followed by heated chemotherapy given directly into the abdominal cavity while the patient is still in surgery (known as heated intraoperative chemotherapy, or HIPEC). This type of  chemotherapy is regarded as being more effective than standard chemotherapy.

Pericardial Mesothelioma Surgery

Mesothelioma of the pericardium (the membrane surrounding the heart) is very rare. Because it is so uncommon, there’s no standard treatment for this cancer, but when diagnosed early enough a pericardiectomy may be performed in an attempt to lengthen the patient’s life and relieve suffering.

Pericardiectomy

Pericardiectomy—also known as pericardial stripping—is a procedure to remove all or a portion of the pericardium. While the pericardium has a protective effect on the heart, it is not essential for normal heart function. If the cancerous pericardium is not removed, patients survive only an average of six months.

Tunica Vaginalis Testis Mesothelioma Surgery

Mesothelioma affecting the testicular membrane is the rarest form of the disease. A lack of characteristic clinical features and in some cases, a lack of symptoms, makes testicular mesothelioma difficult to diagnose. A diagnosis of mesothelioma is often only made during or after surgery. Upon detection, a number of surgical treatment options are possible.

About the Author - 

Lisa Hyde-Barrett has helped ease the stress of patients and their families by offering a comforting hand. Lisa has 25 years of experience as a thoracic surgery nurse. She is passionate about helping the mesothelioma community.

Published: Jul 22, 2013 - Updated: Oct 14, 2015
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