Mesothelioma Surgery

When an individual is diagnosed with cancer, one of the first topics discussed with the oncologist will be the options for treatment. Suggestions for appropriate treatments vary from patient to patient and according to what kind of cancer is discovered. Mesothelioma, in particular, is a very serious and aggressive form of cancer for which treatment options have traditionally been quite limited.

When a recently-diagnosed mesothelioma patient is presented with options for treatment, surgery sometimes enters the picture. Mesothelioma surgery comes in a variety of forms. Some are proposed as a curative measure, others are designed to relieve symptoms of the disease that can be quite debilitating and interfere with the patient's quality of life.

Curative Surgeries

Because of the nature of mesothelioma and the fact that by the time a mesothelioma diagnosis has been made the disease has usually reached an advanced stage, surgery that will result in a mesothelioma cure is not likely to be an option. However, in some cases, this type of surgery is suggested in order to remove as much mesothelioma cancer as possible. The procedure is often followed by other mesothelioma treatments such as chemotherapy or radiation.

Ideally, candidates for these surgeries will be in mesothelioma Stage 1 or 2 - the early stages of the disease where the tumor is still fairly localized and metastases has not occurred. In addition, the patient will need to be in overall good health and free of other medical issues that can complicate these procedures and lengthen the recovery period after the surgery. Extant medical issues - like heart disease, hypertension, and diabetes - are often an issue with older mesothelioma patients, further limiting treatment options and making aggressive surgical procedures an unlikely choice.

However, if the doctor determines the patient is strong enough, the following surgeries may be recommended:

Pleurectomy - A pleurectomy involves the removal of the visceral and parietal pleura, which is the lining of the lungs. This may be used as a potential curative procedure but also may be performed to address pleural effusion, the build-up of fluid in the lungs. This surgery is performed under general anesthesia. To perform a pleurectomy, an incision is made in the affected area, which has been numbed with a local anesthesia. Through this incision, both the inner and outer linings of the lungs are removed. The surgeon may also opt to remove the lung tissue beneath the pleura. The procedure is sometimes followed by chemo or radiation to remove any remaining cancerous tissue. The post-surgery stay for the pleurectomy is generally about a week but may be longer if complications arise during or after surgery, including bleeding or infection.
Pneumonectomy - A pneumonectomy is a radical surgery that involves the removal of the diseased lung. Candidates for this procedure have mesothelioma that is limited to just one lung. Performed under general anesthesia, this is quite a complicated surgery that can take up to three hours to perform. During the surgery, the diseased lung will be deflated and after several steps to prevent bleeding into the chest cavity, the lung is removed through a fairly large incision. At times, part of the fifth rib must be removed as well to provide better access to the lung. A drainage tube will then be inserted and the incision closed. The patient will remain in surgical intensive care for about 48 hours and then in a regular hospital room for one to two weeks, depending on complications, which are very common with this procedure and occur in some 50 percent of patients. It can also take up to six months for the healthy lung to learn to do the job of both lungs; hence, shortness of breath is a considerable problem for pneumonectomy patients and many take several months to resume their normal activity.
Extrapleural pneumonectomy - Recommended only in rare cases, this surgery involves the removal of the affected lung as well as the areas surrounding it. It is a very risky surgery and carries with it a long list of complications including heart failure and serious gastrointestinal problems. The procedure is similar to that of the pneumonectomy and candidates are those who are in the earlier stages of mesothelioma, which has not spread to the lymph nodes. Candidates should also be in otherwise good health. The recovery period can last for up to a half-year or longer.

Palliative Surgeries

Surgeries that relieve mesothelioma symptoms like pain and other problems associated with mesothelioma disease are as follows:

Pleurocentesis - This procedure is used to address pleural effusion, the build-up of fluid in the pleural area surrounding the lungs. The fluid can make it very painful and difficult for a mesothelioma patient to breathe. The procedure is performed in an outpatient area by means of a long, thin needle that is inserted into the pleural space to withdraw fluid. The patient may return home a few hours after the procedure is complete and when the doctor is satisfied that no adverse reactions will occur.
Paracentesis - Essentially the same procedure as the thoracentesis, this one is used to help patients with peritoneal mesothelioma, removing fluid that has collected in the abdominal area.
Pleurodesis - This more serious surgery is used to halt the build-up of fluid for a longer amount of time and involves inserting talc into the pleural space. The talc causes inflammation and stops the fluid from collecting, often for as long as a few years. It is an inpatient procedure performed under general anesthetic, requiring a hospital stay of at least 72 hours, during which time a chest tube may remain in place to drain any additional fluids. Recovery time is 6 to 8 weeks for most patients.

Sources

http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc_name=pleurectomy&content_id=274

http://www.surgeryencyclopedia.com/Pa-St/Pneumonectomy.html

http://thoracic.surgery.ucsf.edu/conditions--procedures/extrapleural-pneumonectomy.aspx

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