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Surgery As Primary Mesothelioma Treatment

Surgery is a common treatment option for mesothelioma and is often combined with chemotherapy, radiation, and other therapies to improve survival rates and overall quality of life.

Whether or not a patient is a good candidate for a curative surgical procedure is dependent on many factors, including the stage of their disease as well as the location and type of their tumors. In early stages, surgical options may be available to patients to remove as much of the cancer as possible. In this case, doctors aim to remove the mesothelioma tumor(s) and attempt to completely eradicate the cancer from the body. In later stages when resection options are no longer available, surgery may be used to provide palliative relief.

The purpose of a palliative procedure is to minimize the painful symptoms caused by mesothelioma. Some of the procedures used for palliative care are also used in curative care, including a talc pleurodesis or even a surgical resection to remove the tumors. The difference is that palliative surgery is focused on comfort while curative surgery is focused on completely removing the cancerous tumors.

Surgery is also often required during the diagnostic process for mesothelioma, as a biopsy is the only definitive way to diagnose the disease.

Pleural Mesothelioma Surgery

This is an image showing where pleural mesothelioma affects a patient.Pleural mesothelioma affects the lining of the chest cavity and is the most common form of the disease. Common procedures used to treat early-stage pleural mesothelioma include extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D). EPP involves the complete removal of the affected lung, whereas P/D only removes the lining of the affected lung.

Surgery can also be used as a diagnostic tool and as a palliative treatment for symptom relief in advanced-stage mesothelioma cases. Thoracotomy, thoracoscopy, and mediastinoscopy are biopsies commonly used for diagnosing pleural mesothelioma, as well as for providing palliative care.

 

Video Transcript

 

“An extrapleural pneumonectomy-the definition is you take the pleura, which is the lining of the lung, the lung itself, and the diaphragm, the muscle between your chest and belly that helps you breathe, and the pericardium, the covering of the heart, and you remove that, with the tumor in the middle. Theoretically, it makes more sense this would get rid of the tumor, but practically, you don’t see it. Now, you’ve got to realize, you’ve lost that lung, and if you get mesothelioma that returns, which most of the time it will, where’s it going to return? The other chest, or in the abdomen. It’s like you painted yourself into a corner. That’s why the pleurectomy decortication is better, it allows you to keep fighting. The best analogy is like peeling an orange. So you take the orange peel and that’s the tumor and you pull that off, but the orange doesn’t have cancer in it. The lung doesn’t have cancer in it. The cancer is coming around it. So you get rid of that and now the patient has a big expanded lung. Now they can tolerate other treatments better. And when the cancer comes back, whether it’s here or there, they have more of a reserve.” -Dr. Raja Flores

 

Extrapleural pneumonectomy (EPP)

During extrapleural pneumonectomy, the surgeon removes the lung, as well as the pleural lining and diaphragm on the affected side of the body, part of the pericardium (lining of the heart sac), and the nearby lymph nodes. The doctor then replaces the removed diaphragm and heart sac using reconstructed man-made replicas.

Due to the invasive nature of the operation, not everyone is a candidate for EPP. The operation is usually only available to patients with resectable epithelioid mesothelioma that has not yet spread to the lymphatic system. Patients must pass a number of tests in order to qualify for this procedure and complications are fairly common. The American Cancer Society notes that about one in three people receiving an EPP operation may experience major complications such as blood clots, fluid buildup, changes in heart rhythm, and impaired lung function.

Pleurectomy with decortication (P/D)

Patients with pleural mesothelioma may also be candidates for the pleurectomy with decortication procedure. This operation removes the pleural lining in the chest cavity, as well as the pleura coating and sometimes part of the diaphragm. The affected lung is not removed. This is more commonly performed than EPP.

In early-stage mesothelioma, this surgery can provide a curative option. However, it can still be used in later stages to provide palliative treatment, alleviating symptoms like fluid buildup and breathing difficulties.

Diagnostic and palliative surgeries for pleural mesothelioma

Mediastinoscopy
Doctors use this camera-assisted biopsy procedure to see if mesothelioma has spread to the lymph nodes.
Pleurodesis
During this procedure, doctors administer medicine into the lung cavity to seal the space between the outer lung and the pleural cavity. It helps to prevent painful fluid buildup (called pleural effusion) and encourages proper lung function.
Thoracentesis
This procedure uses a needle to drain fluid buildup in the chest cavity. It can help with breathing difficulties and chest pain caused by pleural mesothelioma.
Thoracotomy
A surgical biopsy used to either collect a diagnostic sample of a tumor in the pleural cavity or as a resective surgery to remove the tumor.
Thoracoscopy
Doctors use this procedure to view the chest cavity and collect diagnostic samples. It can also be used as a palliative treatment to drain fluid buildup.

Peritoneal Mesothelioma Surgery

This is a picture of where peritoneal mesothelioma affects the patient.Peritoneal mesothelioma affects the lining of the abdominal cavity and is the second most common form of the disease. Due to the available treatment options, peritoneal mesothelioma tends to have a more favorable prognosis than other forms of the disease. The most successful treatment option for peritoneal mesothelioma is a multimodal approach that includes cytoreductive surgery and heated intraoperative or intraperitoneal chemotherapy (chemotherapy drugs administered directly into the abdomen, often abbreviated as HIPEC).

Additionally, surgeries like laparotomy and laparoscopy may be used to diagnose peritoneal mesothelioma. They can also be used as palliative treatments to relieve pain and alleviate symptoms.

Cytoreductive surgery + HIPEC

Peritonectomy is the most common surgery used to treat peritoneal mesothelioma. The procedure combines cytoreductive surgery and a heated chemotherapy wash. It can be used as a curative option to completely remove the mesothelial tumors and prevent the growth of new cancerous cells. In later stages of the disease, this multimodal treatment option can provide patients with symptom relief.

Diagnostic and palliative surgeries for peritoneal mesothelioma

Laparoscopy
A camera-assisted biopsy doctors use to view the abdomen and collect a diagnostic sample of tissue.
Laparotomy
This surgical biopsy allows doctors to not only take a sample of the affected tissue but also serves as a resection procedure to remove the tumor.
Paracentesis
In this procedure, doctors use a needle to remove fluid buildup in the abdomen (called ascites). This can be helpful for patients living with swelling and discomfort caused by peritoneal mesothelioma.

Pericardial Mesothelioma Surgery

This is a picture of where pericardial mesothelioma affects the patient.Pericardial mesothelioma affects the pericardium (the lining of the heart) and is extremely rare, accounting for less than 1 percent of all mesothelioma cases. Due to its rarity, the pericardial form of mesothelioma is usually not diagnosed until the patient has passed away.

Pericardial mesothelioma can lead to constrictive pericarditis, a condition that causes the heart sac to stiffen and prevents the heart from functioning properly. A pericardiectomy may be performed to treat this condition. During a pericardiectomy, the pericardial lining (pericardium) is removed.

Diagnostic and palliative surgery for pericardial mesothelioma

Pericardiocentesis
Also referred to as a pericardial tap, this procedure uses a needle and catheter to remove fluid from the heart sac. It can help relieve pain and alleviate shortness of breath caused by pericardial mesothelioma.

Costs of Surgical Treatment

As with any cancer, treating mesothelioma can quickly become financially draining, especially when surgery is a part of your treatment plan. In addition to the surgery itself, related surgical costs can include:

  • Anesthesia
  • Follow-up visits
  • Hospital room
  • Postoperative costs
  • Prescriptions
  • Travel and hotel (if being treated outside of your area)

However, because most people were exposed to asbestos (the cause of mesothelioma) due to negligence, anyone diagnosed with mesothelioma is likely eligible for financial compensation. This compensation can significantly offset the cost of treatment and may even cover it entirely. Speak with a lawyer today to learn about legal and financial assistance for mesothelioma treatment.

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