Mesothelioma Surgery

Surgery is a common way to treat mesothelioma, particularly when the disease is caught in an early stage. Once they identify and locate tumors and other trouble spots, surgeons like to remove all the cancerous tissues they can find. Sometimes, though, infected parts of the body must be treated in other ways.

Surgeries fall into three areas:

• Potentially Curative: Major surgery and has the potential to be life-changing.
• Palliative: Goal is the restore some quality of life by easing a patient's symptoms or pain.
• Diagnostic: Most basic of procedures, gives patients and doctors an idea of where things stand.

Doctors assess each patient for what procedures make the most sense. They take into account several factors, including the stage of the disease and the overall health of the patient. Many of the procedures are considered palliative and are followed by chemotherapy or radiation therapy, what doctors call a multimodal treatment approach.

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Potentially Curative Surgery

Potentially curative surgery is a major operation - and, as the name suggests, possibly life-changing. But not everybody who has mesothelioma qualifies for such surgery. Patients who want to consider this surgery generally must have good health on their side. Doctors want to be sure that this kind of patient can withstand the rigors of a difficult surgery and arduous rehabilitation.

Typical procedures include pleurectomy/decortication (P/D) and extrapleural pneumonectomy. Developed by Dr. Robert Cameron, P/D has shown to prolong survival in some patients while providing additional complications in others. Dr. Cameron began developing this procedure in 1994 and has performed it on more patients than any other surgeon.

Both P/D and extrapleural pneumonectomy are recommended for patients with an early stage of pleural mesothelioma. When performed on patients with a Stage 3 or 4 diagnosis, survival rates are not as high.

Pleurectomy Decortication

Median Survival Time {Months}

Studies By:
Dr. Rusch 1996 Median Survival 18.3 months
Dr. Pass 1997 Median Survival 14.5 months
Dr. Allen 1994 Median Survival 9 months
Dr. Achatzy 1989 Median Survival 10 months

Pleurectomy Decortication

A pleurectomy/decortication is a procedure that attempts to remove all or part of the affected lung lining. Although a pleurectomy/decortication has demonstrated increased survival rates in some mesothelioma patients, the procedure may pose higher risks for complications after surgery.
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Extrapleural Pneumonectomy

Median Survival Time {Months}

Studies By:
Dr. Sugarbaker 1999 Median Survival 19 months
Dr. Allen 1994 Median Survival 13.3 months
Dr. Rusch 1996 Median Survival 9.9 months
Dr. Pass 1997 Median Survival 9.4 months

Extrapleural Pneumonectomy

An extrapleural pneumonectomy is an aggressive operation that involves the removal of the affected lung, part of the pericardium, part of the diaphragm, and part of the parietal pleura. The procedure is typically performed on patients in the earliest stage of pleural mesothelioma development
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Palliative Surgery

Palliative surgery for mesothelioma patients may involve the removal of cancerous tissue or the drainage of excess fluid to provide relief from symptoms and alleviate pain. While palliative surgery does not offer a cure, such treatment has improved quality of life and prolonged survival.

Pleurodesis

Pleurodesis is a palliative treatment option for those coping with pleural mesothelioma. This procedure is performed when pleural effusion is present. Pleural effusion is the buildup of fluid in the lungs, which can cause considerable pain and breathing difficulties.
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Paracentesis

Paracentesis involves the removal of fluid that has built up in the abdominal cavity of patients with peritoneal mesothelioma. This fluid collection in the peritoneal cavity can cause pain and discomfort due to the pressure the fluid places on internal organs. During a paracentesis procedure, the fluid is removed through a long, hollow needle that is inserted into the abdomen.
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Thoracotomy

Thoracotomy is a generic term that refers to lung surgery and the procedure can be performed on patients with pleural mesothelioma. There are three main types of thoracotomy procedures, including wedge resection, lobectomy and pneumonectomy. In cases where only small, localized tumors are present, a wedge resection may be performed to remove the tumor, while leaving as much healthy tissue as possible intact. In a lobectomy, one or more of the five lobes of the lungs are removed. The third option is a pneumonectomy, in which an entire lung is removed.
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Diagnostic Surgery

Doctors use diagnostic surgery to confirm the presence and whereabouts of cancer. This is typically accomplished with biopsies, removing suspected bad tissue from inside the body to determine that they are, in fact, cancerous. Some of the more common biopsies include fine needle aspiration, incisional/core biopsy and excisional biopsy.

Tube is inserted to collect tissue samples.

Fine needle aspiration biopsies use a hollow needle to gather sample cells for testing. Results from this biopsy are available within a few minutes. Incisional/core biopsies only remove a small section of suspicious tissue for further evaluation. An excisional biopsy involves the removal of an entire tumor or organ for diagnosis.

Typical biopsies for patients with lung conditions include thoracentesis and thoracoscopy, which can be used to diagnose patients who are suspected to have pleural mesothelioma or another lung condition.
Learn More About Biopsies

A thoracentesis is used to diagnose patients who are suspected to have pleural mesothelioma. The procedure may also be used as a palliative treatment for patients who are experiencing excess fluid in the lungs. Such fluid is removed by inserting a hollow needle into the lungs. The fluid is then analyzed for the presence of disease.
Learn More About Thoracentesis

During a thoracoscopy, a doctor makes an incision in the chest. A long, thin tube is inserted into the tissue surrounding the lungs, called the pleura. The doctor probes the pleura and takes samples of suspected mesothelioma cancer cells for testing.
Learn More About Thoracoscopy

Looking for a Doctor?

A mesothelioma specialist will consider several factors to determine the most effective therapy. Surgery is one of the most commonly performed treatments, and certain mesothelioma tumors are potentially resectable. Asbestos.com's Doctor Match Program is now helping patients get matched with top mesothelioma specialists around the country. If you wish to take advantage of this free service, please call us at (800) 549-0544 or click here to visit our doctor match page.

Sources:

1. Pass, I., Vogelzang, N., Carbone, M. Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Transitional Therapies. Springer: New York. 2005.
2. Baldi, A., Mesothelioma from Bench Side to Clinic. Nova Biomedical Books: New York. 2008.
3. http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm
4. http://www.webmd.com/brain/paracentesis-17042
5. http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/23692.html