Surgery for Mesothelioma Cancer

Surgery for mesothelioma is used to remove tumors and also to relieve symptoms. The most common surgeries for mesothelioma patients are pleurectomy/decortication and extrapleural pneumonectomy. Patients most often receive chemotherapy, immunotherapy, or radiation therapy before or after surgery.

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How Is Surgery Used for Mesothelioma?

Surgery is one of several treatment options for many patients with mesothelioma. It is also a diagnostic tool and a strategy for managing symptoms in some patients.

The goals of surgery for mesothelioma include:

• Treating or curing mesothelioma. For patients eligible for a procedure, surgery can reduce tumor size and be part of a plan to achieve remission. This is rare in mesothelioma, but even when a cure isn’t possible, surgery can help extend life expectancy.
• Managing the symptoms of mesothelioma. Palliative care is any treatment offered not to treat or cure the cancer but to relieve symptoms. Surgery can provide symptom relief for many patients with mesothelioma.
• Diagnosing mesothelioma. Doctors often use one of several biopsy procedures to remove abnormal tissue for a diagnosis. These procedures are typically minimally invasive.

Surgery as Part of Multimodal Mesothelioma Treatment

Mesothelioma is almost always treated with a multimodal approach. This means that doctors use two or more types of treatment to manage the cancer.

Patients who qualify for surgery will not undergo surgery alone. They might receive chemotherapy first to shrink tumors before surgery. Or, they could get quimioterapia o radiation therapy after surgery to remove any cancer cells the surgeon missed.

Can Mesothelioma Be Cured by Surgery?

Curing mesothelioma is very rare. In fact, most specialists do not use the term cure. They refer to a possibility of remission when cancer is no longer detected. Even with remission, the cancer can return years later.

Mesothelioma is an aggressive cancer that spreads rapidly and is often diagnosed in the later stages when surgery is no longer an option. In stages 3 or 4, the cancer has spread too far to make curative surgery a possibility.

For patients diagnosed in stages 1 or 2, aggressive surgery combined with other treatments could lead to remission.

Although a cure is rarely possible, aggressive surgery can extend life expectancy in many patients, according to research:

• Chemotherapy and no surgery – 18.6 months
• Extrapleural pneumonectomy surgery – 20.9 months
• Pleurectomy/decortication surgery – 24.6 months

Am I Eligible for Mesothelioma Surgery?

Your medical team will evaluate you and determine your eligibility for a surgical procedure. Doctors consider several factors when deciding if a mesothelioma patient can or should have surgery:

1. Cancer Stage. The stage of mesothelioma is one of the most important factors. Many patients diagnosed at an early stage qualify for surgery. If the cancer has spread too far from its original location, surgery is not possible.
2. Cancer Cell Type. Patients with sarcomatoid mesothelioma are generally not good candidates for surgery because of the aggressive nature of the cells. Patients with early-stage epithelioid cell type may qualify.
3. Lung Function. Curative surgery for mesothelioma is aggressive and very hard on the body. Doctors must ensure patients have adequate lung function before proceeding.
4. Age and Overall Health. Patients who are younger and in good overall health can better withstand the risks of radical surgery. They are more likely to be eligible.

Potentially Curative Surgery for Mesothelioma

Surgery is one of the most common and reliably effective treatments for mesothelioma. Most medical teams use it in combination with chemotherapy, radiation therapy, or both.

Potentially curative surgery is the most extensive type of surgery available for mesothelioma patients. Qualifications for this type of surgery are stricter than other surgeries.

Since it is a major surgery, mesothelioma patients must be in good physical shape and health to successfully recover from such an invasive procedure.

Extrapleural Pneumonectomy (EPP)

This form of surgery is most likely to remove the cancer completely. Candidates are those whose cancer has not spread too far. The procedure is extensive, so the patient must also be in optimal health.

EPP consists of removing the lining of the lungs, part of the diaphragm, close lymph nodes, the pericardium, and one lung. Once the procedure is completed, an artificial diaphragm and pericardium are inserted into the patient’s body.

Pleurectomy/Decortication (P/D)

Pleurectomy/decortication is not as invasive as an EPP. It removes the entire pleural tissue from one or both lungs. This form of surgery can also be part of palliative care.

The side effects of these types of surgery will differ depending on the patient. The common side effects include:

• Blood clots
• Bleeding
• Fatiga
• Fiebre
• Neumonía
• Lung Malfunction

Surgery for Peritoneal Mesothelioma

Patients with peritoneal mesothelioma are more likely to be able to achieve remission with surgery. There are a few options:

• Cytoreduction. Also known as debulking surgery, this procedure removes the peritoneum and any other visible tumors in the abdomen.
• Peritonectomy. Often a part of cytoreduction, peritonectomy refers to the removal of the peritoneum.
• Omentectomy. The omentum is a layer of fatty tissue that covers the abdomen. Surgeons might remove this to remove any tumors that spread there or to prevent additional spread.

Many patients with peritoneal mesothelioma qualify for a procedure known as HIPEC that is most likely to lead to remission. A surgeon first performs cytoreduction surgery and then circulates heated chemotherapy drugs throughout the abdominal cavity.

Cytoreduction with HIPEC is now considered a standard therapy for many patients with peritoneal mesothelioma. Some patients live years after receiving this treatment.

Surgery for Pericardial Mesothelioma

Pericardial mesothelioma is a very rare form of mesothelioma that develops around the heart. It is even more difficult to treat than other types because of the location of tumors.

Some patients might benefit from a pericardectomy, a surgery to remove the pericardium. This is a risky procedure, and not all patients qualify.

Another option is a tumor resection, a less extensive procedure to remove some of the diseased pericardium. This will not lead to remission but might extend life expectancy.

Palliative Surgery for Mesothelioma

Palliative surgery is less intrusive than potentially curative surgery. Palliative procedures are used to relieve síntomas and to improve quality of life.

Keep in mind that, like other forms of surgery, palliative surgery is not a cure, nor does it completely remove cancer. Undergoing this type of surgery helps patients live more manageable lives with less pain and fewer symptoms.

There are different types of palliative surgery options for mesothelioma patients:

Pleurodesis

Pleurodesis removes uncomfortable fluid buildup in the lungs. The surgeon makes a tiny incision on the patient’s chest wall and inserts a hollow chest tube. The chest tube allows the harmful fluid to drain out.

Next, physicians insert a talc-like substance into the chest area, which helps seal the lungs to prevent fluid buildup. The chest tube is then left in the chest area for a few days to drain any excess fluid.

toracocentesis

This form of palliative surgery is similar to pleurodesis as it drains fluid buildup from the chest. The difference is that a needle or catheter is placed into the chest instead of a chest tube.

Talc is also not injected into the chest during thoracentesis surgery. The procedure is typically quick and can be repeated several times.

Paracentesis

Paracentesis is a surgery performed on patients with fluid buildup in the peritoneum (the tissue around the abdominal organs). A needle inserted into the peritoneal tissue drains fluid.

Pericardiocentesis

This procedure drains fluid from around the heart in patients with pericardial mesothelioma. A small inserted needle is used to remove fluid.

Diagnostic Surgery

Typically performed with biopsies, physicians perform diagnostic surgery to identify the location and presence of cancer. Once cancer has been determined, the harmful tissues are removed with a hollow biopsy needle or other instruments.

Diagnostic surgery removes a small portion of tissue for a pathologist to examine.

Biopsies can be performed in several different ways. Your physician will ultimately decide which method works best for you:

• Incisional Biopsy: A fragment of the cancerous tissue is removed and sent to diagnostics for testing.

• Fine Needle Aspiration Biopsy: Also known as needle biopsy, this method is used to remove samples of fluids and tissues via a fine needle that’s inserted into the affected area.

• Excisional Biopsy: The entire cancerous tissue, or a large portion of the tissue is removed and sent to diagnostics for testing.

• Core Biopsy: A core biopsy is similar to a fine needle aspiration biopsy as both procedures use needles to remove samples from the body. The difference, however, is that a core biopsy entails using a much larger needle so that the actual tissue is removed instead of just samples.

• Endoscopic biopsy: An endoscope is inserted into the area of the body that’s infected, which allows physicians to view the cancerous cells.

The type of biopsy performed will depend upon several factors, including:

• The shape, size, and location of the tumor
• Patient preference (if applicable)
• Patient medical history
• The experience and training of the performing physician
• The number of tumors/cancerous cells present
• La etapa del cáncer

Doctors will weigh various factors before determining which type of surgery is most suitable. In some cases, surgery is not suitable, and doctors will move on to other treatment plans.

Almost all malignant mesothelioma surgery patients use a combination of different treatments to get the maximum benefits while battling mesothelioma.

Risks and Complications of Mesothelioma Surgery

Any kind of surgery poses risks. The more extensive and invasive the surgery, the bigger the risks. If the patient is in poor health or is older, these factors can also make surgery more risky.

Mesothelioma patients and their doctors must weigh the risks of surgical treatments against the potential benefits when deciding on treatment.

Some of the potential complications of undergoing mesothelioma surgery include:

• Excessive bleeding
• Blood clots
• Infection
• Pain
• Collapsed lung
• Organ damage
• Fluid buildup
• Reduced lung function
• Heart arrhythmia

There is always a risk of death with surgery as well. EPP surgery for mesothelioma patients is the riskiest and most likely to be fatal.

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