Surgery Option for Mesothelioma Cancer

In its early stages, some mesothelioma cases may be treated through surgery.

For mesothelioma patients, treatment options can be limited and aggressive. When discussing treatment options with your oncologist, surgery may be recommended. Surgery is often part of a larger treatment plan that can include chemotherapy and/or radiation. Known as a multimodal treatment strategy, surgery is used to remove as much of the cancer as possible, and other treatment options are used before or after surgery to rid the body of as many cancer cells as possible.

Surgery options available to you will depend on the stage of your disease at diagnosis and the state of your general health. For mesothelioma treatment, some surgeries are intended as a curative measure, while others may be palliative and recommended to relieve symptoms of the disease and improve the quality of life of a patient.

If you are a candidate for surgery, the type of surgeon you will be referred to will depend on your type of mesothelioma cancer. If you are suffering from pleural or pericardial mesothelioma, you will be referred to a thoracic surgeon. Thoracic surgeons specialize in surgery involving the heart, lungs and other areas of the chest. If you are suffering from peritoneal mesothelioma, you will be referred to a gastrointestinal surgeon. Gastrointestinal surgeons specialize in surgery involving the abdomen.

Potentially Curative Surgery Options

There are a few curative surgery options available to mesothelioma patients that can potentially improve your prognosis:

• Pleurectomy/decortication (P/D) – P/D surgery involves removing the affected pleura – the lining of the lung – and then removing any visible tumor masses on the lung. This combination surgery is known as a lung-sparing surgery because it doesn’t involve removing an entire lung.
• Pneumonectomy – A pneumonectomy surgery involves the removal of the entire affected lung. Because of the severity of the operation and due to the fact that up to 50 percent of patients experience complications, recovery time can be lengthy following this procedure.
• Extrapleural Pneumonectomy (EPP) – EPP surgery involves the removal of the entire diseased lung, the pleural lining of the chest wall, the affected part of the diaphragm, and the pleural lining of the heart. EPP is considered a radical operation and it is only performed on patients who are in the early stages of cancer. The recovery time following an EPP surgery is lengthy.
• Cytoreduction – For peritoneal mesothelioma patients, cytoreduction surgery is used to remove the peritoneum – the lining of the abdomen. Cytoreduction surgery is usually followed by a heated chemotherapy treatment to the abdomen to continue fighting remaining cancer cells.

Palliative Surgery Options

Palliative surgeries are meant to help relieve painful side effects of mesothelioma.

• Pleurodesis – This procedure involves the injection of talc or other chemicals into the chest cavity, which causes scarring and prevents fluid from returning. The American Cancer Society reports that this procedure has about a 90% success rate and that it will eliminate or significantly reduce the build-up of fluid at least temporarily in a majority of patients. Because this is a surgical procedure that requires anesthesia, a short hospital stay is in order.
• Paracentesis – Similar to the pleurocentesis procedure, a paracentesis procedure is performed to remove fluid build up from the abdominal cavity to relieve symptoms associated with peritoneal mesothelioma.
• Thoracentesis – This procedure is often used to determine why a pleural effusion is present in a patient. The procedure involves removing a small amount of the excess fluid to send to a pathology lab for analysis. Thoracentesis can also serve as a palliative procedure by removing the pleural effusion and relieving a patient of the symptoms and discomfort it causes.
  
  Source:
  1 American Cancer Society. Detailed Guide: Surgery for malignant mesothelioma
  2 National Cancer Institute, Malignant Mesothelioma Treatment (PDQ®), Treatment Option Overview.
  3 Treasure, T. et al. Radical Surgery for Mesothelioma. British Medical Journal. 2004;328:237-238. 31 January 2007. http://www.bmj.com/content/328/7434/237.
  4 https://www.maacenter.org/treatment/surgery

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