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For patients who have just been diagnosed with malignant mesothelioma, surgery is typically one of the standard treatment options doctors will want to consider. Depending on your health and the stage of your cancer, mesothelioma surgery may be used to prolong your life, prevent symptoms or ease your pain.

Typically, surgeries are divided into three types:

Diagnostic Surgeries: As soon as a doctor suspects a person is showing symptoms of mesothelioma, diagnostic surgery techniques may be used to explore the chest or abdominal cavities to check for definitive signs of the cancer.

Some examples of diagnostic surgeries for mesothelioma are thoracoscopy, laparoscopy, thoracotomy and laparotomy.

Potentially Curative Surgeries: Mesothelioma 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 illness 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 to 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.

Some examples of potentially curative surgeries for mesothelioma are extrapleural pneumonectomy and pleurectomy/decortication.

Palliative Surgeries: Not all patients are healthy enough for very invasive mesothelioma surgeries. And sometimes the cancer is too widespread to be removed completely. In these instances, “palliative surgery” — or surgery meant to ease cancer symptoms — may be performed. Palliative mesothelioma surgery can ease a person’s pain and improve the quality of life.

Some examples of palliative surgeries for mesothelioma are pleurocentesis, paracentesis and pleurodesis.

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

Pleural mesothelioma, which attacks the lining of the chest cavity and the tissue lining the lungs, is the most common form of the cancer. There are several mesothelioma surgical treatment options your doctor may consider to fight this type of cancer:

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Pluerectomy/Decortication

Pleurectomy/decortication (P/D) is a less severe alternative to the EPP operation in which the lung and diaphragm are not removed. However, the surgeon does remove the pleura lining of the chest cavity and the lung on the side affected by the cancer. The surgeon also removes the tissue lining the mediastinum (the area that contains all chest cavity organs other than the lungs) and the diaphragm. In a radical P/D, the surgeon may remove the diaphragm itself and the pericardium, or the sac surrounding the heart.

This mesothelioma surgery can be considered potentially curative if the cancer is caught early, but it can also help relieve symptoms in cases where the whole tumor cannot be taken out.

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Extrapleural Pneumonectomy

The alternative to P/D is the extrapleural pneumonectomy (EPP) is a very difficult surgery in which the doctor removes the affected lung, the pleura lining the chest cavity and the diaphragm on the affected side, the pericardium tissue surrounding the heart, and lymph nodes near the affected area, the American Cancer Society explains. The surgeon then rebuilds the diaphragm and the pericardium with artificial materials.

This mesothelioma surgery is extreme, but it gives patients a better chance of total removal of the cancer. However, it is generally only an option for patients who are overall healthy and in an early stage of the disease.

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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 can prevent fluid build-up in the pleural space and the recurrence of pleural effusions. In this operation, the surgeon fuses together the parietal pleura (which lines the thoracic cavity) and the visceral pleura (which lines the lungs), obliterating the space between them. This is the most commonly performed palliative procedure.

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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.

Segmentectomy of the Lung

Segmentectomy of the lung involves removing a portion of the lung, rather than removing the entire organ.

Lobectomy

Lobectomy is surgery where one of the affected lobes of the lung is removed, instead of removing the entire lung. There are two lobes in the left lung and three in the right.

Pleurocentesis or Thoracentesis

Pleurocentesis or thoracentesis can be performed to remove fluid buildup in the chest cavity. These techniques can be used as both a diagnostic measure to determine whether mesothelioma is causing the buildup or as a palliative measure to relieve symptoms.

Peritoneal Mesothelioma Surgery

Peritoneal mesothelioma, which targets cancer in the abdominal cavity, may be considered potentially curative or palliative based on the stage of the disease. However, 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 or debulking surgery aims 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 (the lining of the abdominal cavity), but also on the abdominal organs, including the spleen, pancreas, intestines, liver, colon, uterus, ovaries, stomach, bladder and gallbladder. Typically, cytoreduction is followed by heated chemotherapy, known as HIPEC, given directly into the abdominal cavity while the patient is still in surgery.

Omentectomy may be performed if the cancer has spread to the omentum, which is a layer of fatty tissue that hangs over the abdominal organs. This type of mesothelioma surgery removes the omentum.

Paracentesis is a less invasive procedure where the doctor removes ascetic fluid from the peritoneal cavity. The procedure can be used as a diagnostic or a palliative measure.

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. However, when the cancer is diagnosed early enough, surgery may be an option to lengthen the patient’s life and relieve suffering.

Pericardiectomy — also known as pericardial stripping — is a procedure to remove all or a portion of the pericardium. Although 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.

Pericardiocentesis is a procedure in which the doctor removes fluid buildup from the pericardial sac. The procedure may be used to diagnose pericardial mesothelioma or as a means to treat symptoms.

Testicular Mesothelioma Surgery

Tunica vaginalis testis mesothelioma, which affects the testicular membrane, is the rarest form of the disease. A lack of characteristic clinical features and, in some cases, a lack of symptoms make testicular mesothelioma difficult to diagnose. A diagnosis of mesothelioma is often only made during or after surgery.

Removal of the testicle is the most likely treatment for testicular mesothelioma. A doctor will perform this procedure with the goal of removing the cancer before it can spread to other parts of the body.

What to Expect from the Mesothelioma Surgery Recovery Process

Recovering from mesothelioma surgery can be a grueling process, depending on how invasive the surgery was. For some people, hospitalization may be required for a week or more, followed by extensive rehabilitative therapies. For others, less invasive surgery may be performed on an outpatient basis, but it could still take several weeks to recover.

Be sure to talk with your doctor about what to expect from the mesothelioma surgery recovery process, as well as what additional treatments you may need.

Beyond Surgical Treatment: Multimodal Therapies for Mesothelioma

Whether surgery is ultimately 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.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is administered during abdominal surgery immediately after all signs of the cancer have been removed.

In addition to chemotherapy and radiation, mesothelioma patients may consider immunotherapy or photodynamic therapy as part of their treatment regimen.

What Mesothelioma Surgery Option Is Right for You?

Mesothelioma surgery results vary widely depending on the type of surgery you are undergoing and the expectations you and your medical provider have for the procedure. It is important to note that although there is no cure for mesothelioma, surgery can provide patients with hope for a longer and more comfortable life.

When considering all the options for mesothelioma surgical treatment, you and your doctor should discuss:

  • Your general health and whether your body is well enough to tolerate surgery
  • The location of the cancer and what organs might be affected
  • The stage of the disease and whether it has spread
  • What additional treatment options you should consider

Deciding on a mesothelioma treatment plan can be complicated, but having a knowledgeable and compassionate doctor on your team can make a huge difference. To find a mesothelioma specialist in your area, please visit our mesothelioma doctor and hospital guide.

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: Sep 22, 2016
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