Mesothelioma Surgery

Mesothelioma Surgery Options

Mesothelioma surgeries are medical procedures that remove cancer cells from a person’s body. Surgery is a way to treat mesothelioma. But it can also help diagnose cancer, manage symptoms and boost quality of life.

Each patient’s mesothelioma surgery options depend on several factors. These include the patient’s:

• Overall health
• Stage at diagnosis
• Type of mesothelioma

Some patients may be eligible for multimodal treatment, which combines two or more therapies. It is often the most effective way to extend life expectancy for mesothelioma patients. Treatment plans commonly include surgery with radiation, chemotherapy or immunotherapy.

Doctors weigh many factors when recommending any mesothelioma treatment, including surgery. One of the most important considerations is the treatment goal. There is currently no cure for malignant mesothelioma. This means procedures generally aim to diagnose cancer, shrink tumors or ease symptoms.

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Surgery for Pleural Mesothelioma

Pleural mesothelioma surgeries range from minor to extensive. In general, symptom-management procedures are less serious. Surgeries intended to extend life are more aggressive operations. Common pleural mesothelioma surgeries include pleurectomy/decortication (P/D) and extrapleural pneumonectomy (EPP).

Who Is Eligible for Pleural Mesothelioma Surgery?

In general, pleural mesothelioma patients who are in good health with stage 3 or lower cancer may qualify for surgery. Factors that can affect eligibility include:

• Ability to engage in everyday activity (also known as performance status)
• Age
• Extent of cancer spread (metastasis)
• Mesothelioma cell type
• Other conditions the patient has (also known as comorbidities)
• Patient preferences
• Stage of cancer at diagnosis

Patients interested in surgery should discuss their options with a mesothelioma surgeon. An experienced specialist can help patients understand the potential risks and benefits.

Surgery for Peritoneal Mesothelioma

Peritoneal mesothelioma surgeries may aim to improve symptoms or extend survival. Options include cytoreductive surgery (CRS) and paracentesis. CRS is also known as debulking or peritonectomy. It is usually followed by HIPEC. HIPEC stands for hyperthermic intraperitoneal chemotherapy. It is a heated chemotherapy wash applied to the abdomen.

Patients may also undergo other types of chemotherapy after CRS, including:

• Early postoperative intraperitoneal chemotherapy (EPIC)
• Normothermic intraperitoneal chemotherapy (NIPEC)
• Pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Who Is Eligible for Peritoneal Mesothelioma Surgery?

Eligibility for peritoneal mesothelioma surgery depends on several factors, including:

• Age
• Cancer cell type
• How far the cancer has spread (also known as metastasis)
• Other conditions the patient has (also known as comorbidities)
• Stage of disease

Doctors consider these factors when assessing a patient’s eligibility. Some patients who are initially ineligible for surgery may become eligible with the right treatments. For example, PIPAC has reduced tumors enough in some ineligible patients that they became eligible for surgery.

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Surgeries for Rare Types of Mesothelioma

Pericardial and testicular mesothelioma are both rare types of mesothelioma. As such, surgery options for testicular and pericardial mesothelioma are not well documented. Experienced doctors can determine surgery eligibility based on a patient’s individual case.

Surgery Options for Testicular Mesothelioma

Surgery for testicular mesothelioma is not well documented because it is one of the rarest forms of asbestos cancer. It accounts for less than 1% of all mesothelioma cases. Specific treatment guidelines for testicular mesothelioma have not yet been developed. Doctors may recommend a radical orchiectomy to treat this disease. A radical orchiectomy removes a testicle.

Some evidence shows that surgery for testicular mesothelioma is more effective at extending survival than surgery for other types of mesothelioma.

Who Is Eligible for These Types of Surgery?

There are no official treatment guidelines for pericardial or testicular mesothelioma. An experienced doctor can help determine a patient’s eligibility based on their individual case.

Other Mesothelioma Surgeries

Patients with any type of mesothelioma may undergo minor surgeries to help diagnose their conditions. Types of diagnostic surgeries include:

• Laparoscopy: A doctor makes a small incision in the abdomen and inserts a device called a laparoscope. This device can collect samples and also has a camera component. It is commonly used to diagnose peritoneal mesothelioma.
• Laparotomy: A doctor makes a large incision in the abdomen. This allows the doctor to directly collect samples and view tissue. These samples can be used to diagnose peritoneal mesothelioma.
• Mediastinoscopy: A doctor makes a small incision in the chest and inserts a device called a mediastinoscope. The device is similar to a laparoscope. It may be used to diagnose malignant pleural mesothelioma.
• Thoracoscopy: A doctor makes a small incision in the chest and inserts a device called a thoracoscope. The device is similar to a laparoscope. It is recommended for obtaining an adequate biopsy sample in pleural mesothelioma patients.
• Thoracotomy: A doctor makes a large incision in the chest. The procedure is similar to a laparotomy and may be used to collect samples to diagnose pleural mesothelioma.

Mesothelioma patients may also undergo surgery as a form of palliative care. Any surgery intended to treat symptoms or boost quality of life can be considered palliative.

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Mesothelioma Prognosis After Surgery

Surgery-based combination treatments generally provide the best prognosis for mesothelioma. In studies, patients have lived 5 years and longer with this type of treatment. Life expectancy after surgery depends on patient factors and treatment details. Tumor cell type and location can also affect prognosis.

The multimodal plans above extended survival further than individual treatments. Patient survival times for solo treatments include:

• Pleural mesothelioma treated with checkpoint inhibitors: 18 months
• Peritoneal mesothelioma treated with chemotherapy drugs: 13 months

Surgery-based multimodal therapies may improve survival for pericardial and testicular mesothelioma patients. Anyone interested in mesothelioma surgery should discuss their options with an expert. Doctors who specialize in this rare cancer can explain the benefits and risks. They may also recommend clinical trials that offer access to experimental treatments.

Mesothelioma Surgery Side Effects

Like all medical procedures, surgeries come with a risk of negative effects. Common mesothelioma surgery side effects include bleeding, pain, respiratory issues and pneumonia. But these problems don’t affect every patient. Mesothelioma surgeons can explain the likelihood of side effects.

Some factors may increase a person’s chance of experiencing surgery side effects. For example, negative effects may vary if surgery is combined with other treatments, like chemotherapy and radiation. Patients can discuss potential side effects with their oncology teams. After surgery, the mesothelioma cancer center or oncology team can help manage post-surgical conditions.

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What Is the Recovery Process for Mesothelioma Surgery?

The mesothelioma surgery recovery process varies depending on the type of surgery. Patients who undergo more aggressive surgeries may spend several weeks in the hospital. These patients often need extra recovery time at home as well. Other, less invasive surgeries may have quicker recovery times. Other factors, like patient health and surgery side effects, may also affect recovery time.

General recovery processes for each type of surgery may be as follows:

• Diagnostic surgery: Recovery from diagnostic procedures is often relatively quick. Biopsies and other diagnostic surgeries are minimally invasive procedures. For example, patients who undergo a laparoscopy usually recover within a week. Doctors may recommend patients avoid strenuous activity and keep the incision site clean.
• Palliative surgery: Palliative surgeries may be less invasive than therapeutic options. Patients may need days or more than a week to recover. For example, patients who undergo pleurodesis, which collapses the pleural space, may spend 5 – 7 days in the hospital to recover. Patients who undergo a paracentesis to drain excess fluid may only need a day to recover.
• Therapeutic surgery: Therapeutic surgeries are often the most invasive and aggressive. Recovery from a serious procedure may take many weeks to months. For example, a patient may need 8 – 10 weeks to recover from an EPP. Recovery may take longer, depending on various factors.

Patients can talk to their doctors to understand what the recovery process may be like for their specific surgeries.