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Mesothelioma Surgery

Individuals who are diagnosed with pleural mesothelioma will meet with a medical team to determine the best course of treatment for their individual case. Sometimes, if the disease is caught early, they may be a candidate for curative surgery. This is rare with pleural mesothelioma since it is often not diagnosed until it has reached a late stage. More often, patients are advised to have some form of palliative surgery, designed to keep the pleural mesothelioma patient as comfortable as possible by relieving some of the symptoms of the disease.

Pleural Mesothelioma Surgery

Patients with pleural mesothelioma that is caught in the earliest stages (stage 1 or 2) may benefit from an extensive surgery called extrapleural pneumonectomy. A long and complicated operation that’s followed by a long recovery period, this procedure is most often performed on patients with the epithelioid type of mesothelioma tumor. Patients who are candidates for this surgery must be in otherwise good health. Age and other factors may also be taken into consideration.
Extrapleural pneumonectomy involves the removal of the entire lung on the affected side as well as the membrane that covers the lungs, heart and diaphragm. This procedure is usually performed only at major cancer centers, so patients who are candidates for extrapleural pneumonectomy may need to travel away from home to take advantage of this surgery.
The goal of extrapleural pneumonectomy is to remove all or as much of the cancer as possible. Chemotherapy may be used pre-surgery to shrink the tumors and may also be recommended post-surgery if it appears that cancer cells remain. Radiation therapy may also be suggested.
Complications during or after extrapleural pneumonectomy are common and may include:

Heart attack or heart failure
Paralysis of the vocal cords
Gastrointestinal problems
Breathing difficulties that require the use of breathing assistance
Empyema – pus in the pleural space
Chylothorax – the collection of fatty lymphatic fluid in the chest
Bronchopleural fistula – a bonding of the pleura and the breathing tubes, resulting in the release of air from the lungs

Another surgical procedure recommended for pleural mesothelioma patients is called pleurectomy/decortication. This does not offer a cure either but is usually offered as a part of a multimodality treatment plan or as a palliative procedure. During this surgery, the parietal pleura is removed, which is the outermost lining of the lungs. In most cases, this procedure will remove a large portion of the tumor as well. Pleurectomy/decortication can improve the patient’s breathing and relieve pain by controlling the build-up of fluid which generally occurs within the pleural space.

Other Palliative Surgical Procedures for Pleural Mesothelioma Patients

Because the symptoms of pleural mesothelioma are so debilitating, your oncologist or surgeon may recommend a number of surgical procedures that will help ease the effects of these symptoms. Most often, they address the pain and/or breathing difficulties that commonly accompany pleural mesothelioma.
Two procedures can help control fluid build-up in pleural space and, hence, relieve pain and ease breathing. They are not curative.

Thoracentesis – During this procedure, a long, thin needle is inserted into the pleural space to remove the fluid. It is generally done in a doctor’s office with just a local anesthetic. Patients can go home just an hour or two after the thoracentesis is complete. This may be performed several times, if necessary.
Pleurodesis – This is an in-patient surgery performed under general anesthesia. The surgeon will inject talc into the space between the layers of the pleura, which will cause scarring and prevent further build-up of fluid. According to the American Cancer Center, as many as 90 percent of patients receive some relief after pleurodesis surgery.

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