Mesothelioma Surgery: Procedures Overview

Mesothelioma surgery is a common method of treatment for those with up to Stage III mesothelioma, as well as some Stage IV patients depending on the severity and location of tumors. However, most surgical procedures are reserved for Stage I and II mesothelioma where it is most effective and applicable. Cancer that has migrated further from its point of origin is much more difficult to remove with surgery because it affects deeper tissues and more area within the mesothelium.

Surgery has long been the most common treatment for most forms of cancer because it allows thoracic surgeons to remove most or all cancer cells. Removing cancer cells reduces the symptoms of mesothelioma and aids in controlling the spread of the cancer.

Once a patient is diagnosed with mesothelioma, an asbestos related cancer, one of the initial options that oncologist explore is the possibility of removing all or most of the cancer cells.

Cancer cells that are grouped together in the body form tumors that are often discovered during interpretation of x-ray pictures or scans of the patient’s body. This allows oncologist to discover the precise location, size, and severity of mesothelioma cancer. Scans and images also aid in determining the most effective, but least invasive approach for surgical removal of the cancer; also known as resection.

A biopsy of the tumor is the primary method prescribed to determine if the tumor is malignant and the specific type of cancer that is present, which aids in ongoing treatments that follow the surgery. Mesothelioma surgery options are generally chosen and exercised prior to beginning chemotherapy or radiation treatment, two of the most common non-surgical treatment options for cancer patients. By first removing as many cancer cells as possible, chemotherapy and radiation may eliminate any remaining cancer cells that were not detected and removed during surgery.

Mesothelioma Surgery Reasons

Oncologists recommend surgery for either curative or therapeutic reasons.

Curative mesothelioma surgery is intended to remove most of the cancer cells detected in the body. Curative surgery may be recommended in order to remove cell masses, parts of the organ or tissue, or the entire organ in severe cases of malignant mesothelioma. The oncologist must also consider the overall general health of the patient. Some mesothelioma patients with diabetes, heart disease, and other conditions are more at risk for complications due to surgery.

Therapeutic mesothelioma surgery is intended to treat the symptoms of mesothelioma, rather than an attempt to remove the cancer, though in some procedures both of these objectives may be accomplished. Therapeutic mesothelioma surgery may include draining fluids, relieving pressure on blood vessels or nerves, and allowing better flow of air into the lungs.

The table below provides a snapshot of the most common surgical procedures for mesothelioma.

Mesothelioma Surgery – Curative Procedures

There are several surgical procedures an oncologist will explore prior to scheduling a procedure, a decision which hinges on the size and location of the mesothelioma.

Mesothelioma occurring in the lungs, known as pleural mesothelioma, is the most common form of the cancer and therefore offers the most known affective surgical procedures. Pericardial mesothelioma is the least common and the most difficult to address with surgery because it is located on and around the heart, though it is often found to be present in other nearby organs such as the esophagus. Mesothelioma in the abdomen, peritoneal mesothelioma, occurs in some patients and often extends to reproductive organs including the testes and ovaries.

The location and size of mesothelioma is considered when determining which of the following surgeries will be recommended as a curative procedure:

•  Pleurectomy is a mesothelioma cancer surgery in which the lining of the lung (the pleura) is either completely or partially removed.
•  Pneumonectomy is a surgery in which the entire lung infected with mesothelioma is removed. Because of the complexity of the procedure, which includes deflation and cauterizing, the procedure is quite invasive. This mesothelioma surgery requires at least forty eight hours in intensive care and extended hospitalization following the surgery. Recovery time is also slow, as it can take much time to adjust to breathing with a single lung.
•  Extrapleural Pneumonectomy is a surgery which involves a Pneumonectomy as described above, and also includes removing of the lining of the heart (pericardium), chest lining (parietal pleura), as well as part of the diaphragm on the affected side of the chest. This extreme mesothelioma cancer surgery is rarely prescribed if not absolutely necessary, but is reported to provide the best survival rate in some patients.
•  Curative mesothelioma surgeries for cancer near the heart and in the abdomen may include the removal of organ lining, in cases of peritoneal mesothelioma, oncologists may recommend partial organ removal or whole organ removal

Mesothelioma Surgery – Therapeutic Procedures

Mesothelioma symptoms are often painful and difficult to treat in later stages. Because many patients aren’t diagnosed until those later stages, some therapies to reduce symptoms may include surgery such as those listed below.

•  Pleurectomy is a surgery in which, as mentioned above as a curative surgery, the lining of the lung (the pleura) is either completely or partially removed. This can aid in treating pleural effusion; the buildup of fluid in the pleura that can cause discomfort, difficult breathing, and coughing.
•  Pleurocentesis is a mesothelioma cancer surgery that also addresses the build-up of fluid around the lungs. This is a less-invasive surgery in which a long, thin needle is inserted between the ribs and into the pleura to extract fluid.
•  Paracentesis is performed for symptoms of peritoneal (abdominal) mesothelioma and is employed for the purpose of extracting fluid in the abdomen. Like Pleurocentesis, fluid is drawn away from the abdomen with a long, thin needle.
•  Pleurodesis is a mesothelioma cancer surgery and also attacks fluid build-up. Unlike Pleurocentesis and Paracentesis, the procedure of pleurodesis includes injecting medication into the pleura that reduces the amount of space available for fluid collection in the pleura.

Mesothelioma surgery is also prescribed based on the type of mesothelioma cancer, which is determined by the location of the cancer. Pleural mesothelioma, peritoneal mesothelioma, and pericardial mesothelioma cancers are treated through specifically targeted surgeries that provide the best outcome for each type of cancer patient. Peritoneal mesothelioma occurs in the abdomen, a cavity surrounded by muscle and tissue. Pericardial and pleural mesothelioma occurs on the lungs, which is located behind the rib cage and therefore more difficult to access.