Skip to main content

Mesothelioma Surgery

Having major surgery is considered the best treatment for mesothelioma. It offers the greatest chance for long-term survival. An experienced surgeon can remove all visible signs of before spreading far, you could live for many years after surgery.

Play Video
Mesothelioma Surgery
What Is the Best Treatment for Mesothelioma?

Mesothelioma Surgery

Having major surgery is considered the best treatment for mesothelioma. It offers the greatest chance for long-term survival. An experienced surgeon can remove all visible signs of before spreading far, you could live for many years after surgery.

Before doctors discuss surgery as an option, they will want to make sure your body is strong enough to endure this major procedure and recover from it. Doctors will determine your lung and heart health by test, they will conduct a pulmonary function test and running cardiac tests. These tests may include an electrocardiogram (EKG), stress test, echocardiogram or coronary angiogram.

If determining your overall health is strong enough to withstand potential complications from surgery, and the mesothelioma has not spread too far, your doctor will then approve you as a candidate for surgery. There are risks involved with surgery, but the potential rewards are great. Many survivors who opted for surgeries that gave them many more years to spend with children and grandchildren.

Mesothelioma Surgery

Three Different Purposes of Mesothelioma Surgery

Surgeries for mesothelioma patients typically fall into three categories: diagnostics, tumor removal, and palliative. Sometimes major surgery is not an option; however, a patient can still benefit from a less invasive procedure. Choosing what type of surgery to have is up to the patient and the specialist overseeing their care.

Statistics support surgery as the best first-line treatment option for living longer with this disease. When it comes to each patient’s case, sometimes it is a clear-cut choice, and sometimes the patient’s circumstances make balancing the risk and the reward difficult.

A mesothelioma specialist can conduct a thorough assessment and explain for the patient’s situation what procedures make the most sense. The specialist will take several factors into account, including the stage of cancer and the patient’s overall health.

Diagnostic

A medical team cannot typically make a definitive cancer diagnosis without performing a minor surgery called a biopsy. The procedure extracts a sample of cancer cells for examination.

Tumor Removal

Major surgery to remove tumors can extend life expectancy and potentially even send mesothelioma into remission when performed as part of multimodal therapy.

Palliative

A less invasive alternative to tumor-removing surgery is a Palliative surgery. It aims to improve the quality of life by alleviating pain and other cancer symptoms.

You may also be able to join a clinical trial of an experimental treatment if you qualify for surgery. Mesothelioma patients can be offered by Mesothelioma surgeons to have the opportunity to participate in clinical trials to investigate the best therapies to combine with surgery. This research is slowly improving mesothelioma survival rates.

Pleural Mesothelioma Surgery
Biopsy Procedures
What is Pleural Mesothelioma Surgery?

Pleural Mesothelioma Surgery

Pleural mesothelioma surgical treatment has improved since it began in the 1970s. Most patients still need to travel to a specialty cancer center to see a mesothelioma specialist because of the rarity of this cancer.

Diagnosing Pleural Mesothelioma and Easing Symptoms

Thoracoscopy is the primary diagnostic procedure for pleural mesothelioma. Thoracentesis and pleurodesis, the two main palliative procedures, can also be used for diagnosis.

Thoracoscopy

Video-assisted thoracoscopic surgery (VATS) is also called a thoracoscopy. This procedure involves inserting a special camera and a long, thin probe through small incisions in the chest. These tools allow a doctor to take a biopsy sample from the tissue around the lungs without having to open the entire chest cavity.

Thoracentesis

When fluid builds between the two layers of the pleural lining surrounding the lungs, a doctor can drain it through a hallow needle. This procedure relieves pressure and makes it easier for the patient to breathe. The pleural fluid can be tested for cancer cells as part of the diagnostic process.

Pleurodesis

This procedure, like a thoracentesis, drains fluid buildup. This procedure then goes a step further by sealing the area to prevent fluid from building again in the future. Doctors typically inject talc into the pleural cavity to seal it, although chemicals may be used in certain cases.

Pleural Mesothelioma Surgery

Removing Pleural Mesothelioma Tumors

Doctors primarily use two different tumor-removing surgeries for pleural mesothelioma: Extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). Roughly 15 to 20 percent of people with pleural mesothelioma qualify for tumor-removing surgery.

A general term for a surgery that allows doctors to access a patient’s lungs, heart, aorta, trachea or diaphragm is “Thoracotomy”. It involves making an incision 4–10 inches long on either side of the chest. Extensive procedures, such as EPP and P/D, require a thoracotomy. The first step in several asbestos-related lung cancer surgeries is also a thoracotomy. These surgeries include pneumonectomy, lobectomy, wedge resection, and segmentectomy.

Unfortunately, up to 25 percent of mesothelioma patients cleared for surgery are found to be inoperable after a thoracotomy is performed. Doctors try to predict this with the latest advances in imaging technology and other diagnostic techniques, however, surgeons cannot determine whether a planned tumor-removing surgery is actually possible until they look inside the patient.

In cases where cancer has spread too far for surgery to help, the surgeons will pinpoint the stage of cancer. This can guide the patient’s overall treatment plan. If the cancer is localized, however, the surgeons will proceed with the tumor removal.


Pneumonectomy

Pneumonectomy involves removing a lung. A patient may qualify for this surgery if cancer hasn’t spread beyond one lung. Most surgeons perform more extensive EPP (Extrapleural pneumonectomy) surgery rather than just a pneumonectomy.

Extrapleural pneumonectomy (EPP)

This is an aggressive surgery that removes an entire lung, the lining around it, nearby lymph nodes and parts of the pericardium and diaphragm. Hypothetical, it offers the best chance to remove all cancer cells, but it also permanently reduces the patient’s stamina.

Pleurectomy/decortication (P/D)

This procedure was developed to be a less aggressive alternative to removing a lung. Surgeons remove the pleural lining around the lungs and all visible tumors rather than the entire lung. They scrape the affected lung rather than remove it.

The average hospital stay after a thoracotomy is five to ten days. These surgeries irritate nerve endings near the incision, so the patient will likely experience pain, numbness or burning below their breast and at the front of their rib cage.

Drainage from the incision of clear or pink fluid is normal. You should clean your incision in the shower, washing gently with warm water and mild soap. Avoid submerging the incision in a bathtub or spa for three weeks. Avoid heavy lifting and other strenuous activities for eight weeks. These could put stress on your incision and delay recovery. You can perform breathing exercises and walk every day to improve your strength, circulation and lung capacity.

Peritoneal Mesothelioma Surgery
Surgery for Pleural Mesothelioma

What is Robotic Surgery for Pleural Mesothelioma?

The newest way for thoracic surgeons to conduct cancer surgeries is robotic surgery. In 2006 after the technology proved its effectiveness for minimally invasive procedures, doctors began using it for chest cancer surgeries. In 2013, Dr. Farid Gharagozloo performed the first major robotic surgery for a pleural mesothelioma patient. He used this technique to perform an extrapleural pneumonectomy.

Gharagozloo currently practices at Florida Hospital Celebration Health. The da Vinci Surgical System he uses will change the future of mesothelioma treatment, he says. By using a computer board, surgeons can guide the tiny instruments attached to a robotic arm, allowing for more precise movement. It also allows for a more magnified view and better maneuverability during the operation.

Robotic surgery also significantly reduces blood loss. It shortens postoperative recovery time and lowers the stress on the remaining lung after an EPP. This stress is often a major problem when the surgery is done conventionally.

Mesothelioma Surgery

Diagnosing Peritoneal Mesothelioma and Easing Symptoms

A paracentesis is a minor surgical procedure that can serve as a diagnostic or palliative purpose. Cancer can cause fluid to build up in the peritoneal cavity, the space between the two membranes that separate the abdominal organs from the abdominal wall. Doctors can drain this fluid through a hollow needle to relieve pressure on nearby organs. Ascites, also known as Peritoneal fluid buildup, and this procedure is sometimes called an abdominal tap or an ascitic tap.

Ascitic fluid can be examined by doctors to confirm a diagnosis of peritoneal mesothelioma. Peritoneal effusion, also known as ascites, often reoccurs with peritoneal mesothelioma. With repeated therapeutic paracentesis procedures can be administered as palliative care for patients with advanced stages of this disease.

Peritoneal Mesothelioma Surgery

What is Peritoneal Mesothelioma Surgery?

Peritoneal mesothelioma accounts for less than one-fourth of all mesothelioma cases. It is an uncommon variant of an already rare cancer. It is also more aggressive than the other types of mesothelioma if left untreated. It wasn’t long ago that nearly everyone diagnosed with peritoneal mesothelioma survived only six months on average.

Today, peritoneal mesothelioma patients can benefit from one of the greatest modern advancements in mesothelioma treatment: The HIPEC procedure. Nearly half of peritoneal patients treated with this special combination of surgery and chemotherapy live beyond five years.

Mesothelioma Surgery

Removing Peritoneal Mesothelioma Tumors

Nearly 40 percent of peritoneal mesothelioma patients qualify for tumor-removing surgery. The most effective treatment for this disease combines a peritonectomy with a HIPEC procedure.

Peritonectomy

Within this procedure, surgeons remove the diseased parts of the peritoneal lining of the abdomen. Then they perform cytoreductive surgery to remove as much cancerous growth as possible from the abdominal cavity. This can also be called debulking surgery, and it may involve removing parts of the liver, pancreas, spleen, gall bladder, bowels, and stomach.

Robotic Surgery
HIPEC Treatment
Mesothelioma Treatment

HIPEC Treatment

Hyperthermic intraperitoneal chemotherapy (HIPEC) is given immediately after the debulking phase of the peritonectomy. Specialists in mesothelioma pump a heated mixture of chemotherapy drugs directly into the abdominal cavity. The specialists leave it there for up to two hours so it can be absorbed by any remaining cancer cells.

HIPEC has fewer side effects than oral or intravenous chemotherapy because the drugs are not injected directly into the bloodstream. Targeting chemotherapy in this way allows doctors to use much stronger drugs against cancer. Some of these chemotherapy used does get absorbed into the bloodstream. But, this causes less serve side effects than intravenous chemotherapy.

Mesothelioma Surgery

Pericardial Mesothelioma Surgery

Pericardial mesothelioma patients may experience chest pain, dyspnea (shortness of breath) and coughing. These symptoms are because of a buildup of fluid in the heart lining. A pericardiocentesis can effectively remove fluid buildup to relieve these symptoms.

Unfortunately, pericardial fluid rarely contains malignant cells when mesothelioma is present. This procedure is ineffective for diagnosis.

Pericardiectomy is the tumor-removing surgery available for pericardial mesothelioma. The surgery removes as much cancerous tissue as possible from the heart lining. It can relieve symptoms caused by pericarditis (inflammation of the pericardium) and pericardial effusion (buildup of fluid in the pericardium). It’s important to treat these conditions early before they cause deadly complications.

Cardiac surgeons, also known as heart surgeons, perform pericardiectomies. Patients should ask how many of these procedures a surgeon has performed to gauge the experience level of the physician.

Certain hospitals perform more of these surgeries than others. For example, surgeons at Cleveland Clinic follow the guidance of Dr. Allan Klein, director of the hospital’s Center for the Diagnosis and Treatment of Pericardial Diseases.

Meanwhile, Dr. Jae K. Oh, the director of Cardiac Imaging and the Pericardial Disease Clinic at Mayo Clinic in Rochester, is instrumental in pericardial mesothelioma surgeries performed there.

Pericardial Mesothelioma Surgery
Mesothelioma Treatment

Mesothelioma Surgery Side Effects

The most common side effects of mesothelioma surgery are pain, swelling or infection at the incision site. Whenever a foreign object, such as a needle, knife or tube, is placed into the body, swelling and drainage usually occur. In fact, open drainage is recommended during the healing process.

Mild swelling, draining and bruising of the injured tissues are usual. These side effects will typically resolve themselves on their own within a few days or weeks.

Other side effects of surgery include:

Bleeding

Most patients will experience minimal bleeding that poses no threat to overall health. The body will be able to regenerate any blood that has been lost. During recovery, overstretching or otherwise damaging the incision area can result in bleeding. If bleeding becomes extensive, seek immediate medical attention.

Fatigue

Even after the anesthesia wears off, patients may still feel fatigued from the basic bodily stress that occurs with an invasive procedure. This is especially true after a major operation such as EPP or P/D. The fatigue may be intensified if the patient does not eat enough food or get enough rest to restore the body’s energy levels.

Cardiac complications

Mesothelioma surgeries performed in the chest cavity pose the risk of cardiac complications. The most common risk is atrial fibrillation or cardiac arrhythmia (irregular or abnormal heartbeat).

You should contact your doctor if any symptoms occur in excess. Excessive inflammation or foul-smelling drainage at the surgery site may be a sign of infection. Other signs of infection include redness and a warm or tingling sensation. Postoperative infection should be controlled under a doctor’s care. It is imperative to report infection immediately to prevent it from becoming fatal.

Mesothelioma Surgery

Managing Pain After Surgery

Discomfort after may be dull and tingling or more intense. The pain will occur when they stand, sit, walk or try to perform daily activities for some patients. But the pain may occur even at rest for others.

The patient’s surgeon can help them develop a pain management plan to cope with the discomfort they might experience after surgery. Before they leave the hospital, their doctor will provide a prescription for an oral pain medication.

Over-the-counter (OTC) medications may be recommended to relieve mild pain. These include OTC medications like acetaminophen (Tylenol), ibuprofen (Advil) or naproxen (Aleve). OTC medications should not be taken after surgery without specific instructions from your doctor.

Managing Pain After Surgery
Stages of Pleural Mesothelioma

Pleural Mesothelioma Stages

A doctor will also determine the stage of mesothelioma as part of the diagnostic process, which determines the origin in the lining of the lungs and describes how far it has spread from that point. This information is significant to doctors when determining potential treatment availabilities. Standard treatment options are more commonly available to patients with stage 1 or stage 2 compared to patients with the later 3 and 4 stages.

The following are the pleural mesothelioma stages:

Stage
1

Within Stage 1, the mesothelioma tumor is generally in one location, and the cancerous cells have not dispersed to lymph nodes or other body organs and tissues. In general, surgical treatment may be an option for eliminating the cancerous growth.

 

Stage
2

Within Stage 2, the mesothelioma tumor is larger and has probably intruded on surrounding organs, such as the lung or even diaphragm. Lymph nodes could additionally be included. In this case, surgical reapportion might still be feasible, however much more difficult depending on the scope of the growth.

Stage
3

Within Stage 3, mesothelioma cancer has infested a region or perhaps location. Cancer has progressively spread throughout one side of the chest, within the chest wall, esophagus, and additional lymph nodes. Surgical treatment is typically not an option as curative therapy, however various other treatment options may be attempted. 

Stage
4

Within Stage 4, the mesothelioma has dispersed to numerous locations, such as various other organs and tissues throughout the body. Surgical treatment is no longer an alternative, and most treatments at this stage concentrate on minimizing discomfort and pain.