Surgery Options for Mesothelioma
Mesothelioma cancer is treated on an individual patient basis. There is no one size fits all for every patient who is diagnosed with mesothelioma. In order to create a patient’s overall treatment plan, different types of doctors work together to combine different types of treatments. The recommendations and options for treatment of mesothelioma cancer depend on several different factors, such as, the type and stage of cancer, age and health of the patient, potential side effects of the treatment and the patient’s preferences. All of these pieces together make up the patients treatment plan.
Traditionally, treatment for this serious and very aggressive cancer have been limited. More options have become available, some in the form of surgery. There are different types of surgery for mesothelioma and when surgery is recommended it is either for the purpose curing the cancer, relieve debilitating and painful symptoms of the disease, or to diagnose the cancer type and stage.
There Are Several Types of Surgeries
Surgery labeled as curative is meant to extend the life expectancy of the patient by removing tumors and can dramatically improve their quality of life. Ideal candidates will still be in the early stages of the cancer and the tumor will be localized. It will not have metastasized and the patient will be in good health with now other serious medical issues.
- Wide local excision: This is a surgery that removes the cancer as well as some of the healthy tissue that surrounds it.
- Pleurectomy: Surgery to remove the mesothelial lining of the lung and chest cavity.
- Pleurectomy/Decortication P/D: Surgery that removes all or part of the external surface of an organ. Surgery to remove the covering of the lungs and lining of the chest.
- Pneumonectomy: Surgery to remove all or part of a lung.
- Extrapleural pneumonectomy: Surgery that removes a whole lung and some of the lining of the diaphragm, chest and the sac that is around the heart.
- Pleurodesis: Procedure that uses drugs or chemicals in order to make a scar between the layers of the pleura. Fluid is drained from the space first with a chest tube, then the chemical is put into that space. The subsequent scarring will stop the buildup of fluid inside the pleural cavity.
- Pleurocentesis: Removal of the build of fluid in the space around the lungs.
A Closer Look at Types of Surgery
Pleurectomy Decortication P/D Is an aggressive surgery treatment option for pleural mesothelioma. It is a two part surgery, the first part removes the lining surrounding a lung, and then any additional tumors that are growing inside the chest cavity are removed. The advantage to this surgery is that a patient is able to keep their lungs. The procedure takes about 5 hours.
This surgery is generally performed on patients that are in good health and are also still in the early stages of the disease. Patients who have this surgery can increase their life span significantly, especially when it is combined using the multimodal approach that includes radiation and chemotherapy.
Pleurectomy was at one time a single procedure used mainly for alleviating pain and reducing fluid buildup in the lungs. Today it is seldom performed without the decertification portion which has been made possible new advancements in surgery.
Extrapleural pneumonectomy / EPP is another aggressive surgery in which an entire lung is removed along with parts of the pericardium, diaphragm and nearby lymph nodes. This is a controversial and dangerous surgery and is almost exclusively used to treat malignant pleural mesothelioma, cancer that is confined to the chest cavity. EPP can help control the growth of tumors.
This surgery is performed when the patient is still in the beginning stages of the disease, before the cancer has spread to the lymph nodes or the other surrounding organs. Performing this surgery allows the surgeon to remove the maximum amount of cancerous cells and tissue, however since mesothelioma is often not diagnosed until it reaches stages III or IV, only a few patients are eligible for this type of surgery.
This procedure requires the patient to be under general anesthesia. An incision is made into the chest and the 6th rib may be removed in order to remove the diseased lung. The diseased lung is first collapsed and the major blood vessels are clamped and then the lung is removed, along with the pericardium, pleural lining, and parts of the diaphragm. The space is then patched with synthetic material and finally the incision is sutured closed.
This procedure can increase a patient’s lifespan since it removes most of the cancerous cells. When this procedure is combined with radiation and chemotherapy, it can increase a patient’s life by years. It is a potentially curative procedure and at this time may be the most effective way to treat and control mesothelioma.
Pleurocentesis, also known as thoracentesis, can be performed to relieve the pressure and reduce the pain of the fluid that builds up around the lungs. This procedure can be performed as often as necessary in order to provide relief to the patient and include his/her quality of life.
This procedure is usually done in an outpatient setting after an imaging scan has been done. The scan allows the doctor to determine how much of the fluid is present and he can then proceed to remove it. During the procedure the patient is sitting up and usually leans forward onto a table. The area where the needle will be inserted, generally between the ribs, is numbed and then the doctor inserts the needle. The patient experiences very little pain and after the fluid is removed the area is bandaged. The procedure is usually completed within 30 minutes.
Pleurodesis is an option for patients that have received the diagnosis of pleural effusion. Pleural mesothelioma can cause fluid from the lymph nodes to accumulate within the lining of the chest wall as well as the lining of the lungs. This is treated by injecting a chemical substance into the space that is between the membranes. This is done by either a large needle or a thoracoscope. The procedure causes the pleural membranes to become irritated and inflamed which causes them to bond together which then eliminates the space and thus fluid cannot accumulate.
This procedure can be done either at the bedside or in the operating room. The location is determined by the condition of the patient. When this procedure is done at the bedside, the patient will receive a general anesthetic and the doctor will insert a very large needle into the chest. If the procedure is done in an operating room, the patient will undergo general anesthesia and the doctors will use video-assisted thoracoscopy which aids the surgeon when guiding the needle.
Regardless of where the procedure takes place, the process is the same, the tip of a needle will be inserted into the pleural space which is between the membranes, and then attached to a drainage tube. To avoid a drastic reduction in blood pressure, the fluid is drained slowly and once it has been removed the doctor will used the needle and inject the talc solution into the space.
- “Pleurodesis treatment.” CancerUK.org. http://www.cancerhelp.org.uk/help/default.asp?page=5291
- Eldridge, L., MD. (2012, April 6). Pneumonectomy as a Treatment for Lung Cancer. Retrieved from: http://lungcancer.about.com/od/treatmentoflungcancer/a/pneumonectomy.htm
- Baldi, A., Mesothelioma from Bench Side to Clinic. Nova Biomedical Books: New York. 2008.
- Bhimji, S. (2010, November 1). Biopsy. U.S. National Library of Medicine, National Institutes of Health. Retrieved from: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm