Surgery

In some cases, surgery may be recommended to alleviate symptoms or slow the progression of mesothelioma. Surgery may be performed in tandem with other treatments such as chemotherapy and radiation, also known as “multi-modal therapy.”

As scientists develop tests to diagnose mesothelioma at an earlier stage, surgery could play a role in curing the disease in the future. Doctors specializing in mesothelioma are working toward the goal of using surgery to remove the cancer and the necessary surrounding tissue in an effort to stabilize the disease.

Whether a surgery is recommended for a particular patient will depend on factors unique to each person, including the type and location of the cancer, the “stage” of the cancer and the patient’s overall health.

Even among the subgroup of patients for whom surgery is an appropriate option, there are a variety of surgical procedures that may be considered—some to control the buildup of fluid that can cause such discomfort and others to remove the tumor mass and slow progression of the disease.

For a patient with pleural mesothelioma, which affects the membrane surrounding the lungs, a surgeon may be called up to perform a thoracentesis, pleurodesis or pleurectomy/decortication to relieve or control discomfort and plural effusion, the buildup of fluid around the lungs that can cause pain and shortness of breath. Other surgeries, such as a pneumonectomy or an extrapleural pneumonectomy, remove more extensive tissue in an attempt to slow tumor progression.

For a patient dealing with peritoneal mesothelioma, which attacks the membrane lining the abdomen, the surgeon may relieve a peritoneal effusion, the buildup of fluid in the abdomen, through a paracentesis. The lining of the abdomen, called the peritoneum, may be removed by a peritonectomy. In a cytoreductive surgery, surgeon will open the abdomen and remove every visible sign of cancer.

Finally, for patients dealing with the most rare form of mesothelioma that involves the membrane surrounding the heart (pericardial mesothelioma), a surgeon might perform a pericardiocentesis to drain the buildup of fluid around the heart, or the more aggressive extrapleural pneumonectomy may be used in some cases to remove the tumor and surrounding tissues.

Types of surgery for mesothelioma treatment:

Thoracentesis

This procedure involves the draining of fluid that may build up (called a “pleural effusion”) in the chest between the lung and the pleura. A tube is placed in the chest in order to drain out the fluid. Thoracentesis is a palliative treatment, meaning that its purpose is to help relieve discomfort.

Pleurodesis

Pleurodesis is a surgical procedure to help control pleural effusion, which is the buildup of fluid between the lungs and the lung lining. Pleurodesis closes the space between the lung and the lung lining, reducing the chance for fluid to accumulate.

There are two approaches to performing a pleurodesis. In the first, a tube that is inserted into the chest drains the excess fluid. After this fluid is drained, a schlerosing agent (a substance that causes tissue to scar or harden), such as sterile talc powder, is injected through the chest tube and into the pleural space. The schlerosing agent is allowed to distribute itself through the pleural space, with the patient being asked to move about in order to facilitate the distribution. Once the agent is distributed, suction is applied to the tube in the chest. Similar to collapsing a plastic bag, the suction brings the two pleural surfaces together, allowing them to “scar” together.

The second method of pleurodesis uses thoracoscopy, whereby a small incision, or a series of small incisions, are made in the skin. A thoracoscope is passed through the incision in order to get a better look at the pleura. The schlerosing agent is then applied to the area.

Pleurectomy/decortication

Pleurectomy/decortication involves removing the pleura, where most of the tumor is located. This procedure may help control pleural effusions (fluid buildup) and help to decrease the pain caused by the tumor. It is a palliative treatment, meaning that its goal is to help to lessen the discomfort caused by mesothelioma.

Pneumonectomy

A pneumonectomy is the removal of all or part of the lung. Your surgeon will make an incision in the side of the chest. When the lung is revealed, the surgeon visually assesses the tumor and decides how much tissue should be removed.

Extrapleural Pneumonectomy

This extensive surgery usually involves the removal of the pleura, pericardium, diaphragm and the whole lung on the side of the cancerous tumor. Your surgeon may decide to remove some of the surrounding tissues as well.

Paracentesis

Peritoneal mesothelioma can cause fluid to build up in the abdomen in a process called peritoneal effusion. This excess fluid is drained through a needle and tube inserted into the abdomen. Paracentesis (sometimes called an “ascitic tap”) can help take the pressure off the internal organs, and also helps reduce the risk of infection that may be caused by the fluid buildup. This is a “palliative” procedure, meaning that the goal of paracentesis is to help to relieve the discomfort associated with peritoneal mesothelioma.

Peritonectomy

A “peritonectomy” involves removing the peritoneum, the lining of the abdomen where the mesothelioma first develops. This form of surgery is most often used when the cancer is detected in the very early stages of the disease. Your surgeon might recommend that a peritonectomy be performed in tandem with “intraperitoneal hypothermic perfusion,” a form of heated chemotherapy where the chemotherapy drugs are administered directly into the abdomen during and/or after surgery.

Cytoreductive surgery

During cytoreductive or “debulking” surgery, the surgeon opens the abdominal cavity (a procedure known as a “laparotomy”) to look for all signs of cancer and attempt to remove as much of the tumor as possible. This surgery can be quite long in duration because of the amount of detail the surgeon must use to search for and remove signs of cancer in the abdominal area. Your surgeon might recommend that this surgery be performed in tandem with “intraperitoneal hypothermic perfusion,” a form of heated chemotherapy administered into the abdominal cavity.

Pericardiocentesis

This is the process for drawing fluid out of the affected area to help to relieve the discomfort associated with pericardial mesothelioma. For this procedure, a needle is inserted into the pericardium (the sac around the heart) to drain the fluid and relieve circulatory problems. The draining of this fluid can be associated with complications, however.