Surgery, radiation, and chemotherapy are the 3 main treatments for the asbestos-triggered disease, pleural mesothelioma. They may be used individually, but are commonly used together.

Surgery is used to physically remove tumors from the lung area, but it can also be used to improve a person’s quality of life by lowering pain and symptoms. There are multiple kinds of surgery that may be used for pleural mesothelioma – and each is associated with certain side effects. They may also be associated with complications. The risks of any surgery are extremely important to address together with your doctor.

What Types of Surgery Are Used for Mesothelioma?

There are 2 main types of surgery for pleural mesothelioma. Extrapleural pneumonectomy (EPP) is when a surgeon removes several parts of the lung area affected by cancer. These areas include the lung, lining of the chest wall, and diaphragm on the side that is affected with cancer. It also includes the thin sac around the heart and lymph nodes that may be affected. EPP is an extensive and difficult operation. Many tests on each patient are completed beforehand.
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Pleurectomy is another type of surgery for mesothelioma. In this case, the doctor removes parts of the lining around the lungs. Pleurectomy is often used together with decortication. This is a procedure that removes a layer of tissue covering the lungs, chest wall, and diaphragm. In contrast to EPP, the lung and diaphragm are spared. When successful, this procedure allows the lungs to better expand and deflate, and the patient’s symptoms improve. This kind of surgery can help fluid buildup, improve breathing, and reduce pain.

Along with EPP and pleurectomy with decortication (P/D), there are other, less-frequent types of mesothelioma surgery. For example, debulking is a less extensive version of P/D. Less tissue is removed.

What Are Potential Complications of Surgery?

Because procedures such as EPP and P/D are extensive and difficult, they are associated with risks. This is because they involve large incisions and removal of all or part of organs. The American Cancer Society (ACS) estimates that major complications can occur in as many as 1 out of 3 patients who receive these procedures. Side effects and complications often depend on the how extensive the cancer is, along with the patient’s level of overall health.

A difficult challenge with pleural mesothelioma is that the tumors are shaped differently than some of the other tumors surgeons may be used to treating. In most cases, there are many small tumors with different sizes and shapes. This makes them very hard to see and makes it very hard to know how they are affecting the body. Sometimes the cancer has affected many areas together, such as the lungs, pleura, lymph nodes, and others. The more extensive the cancer, the harder it is to perform surgery. Surgeons who perform these surgeries must be extremely knowledgeable and experienced.

EPP is a difficult operation that is done only by very experienced surgeons in large medical centers. The main complication of EPP is reversible atrial fibrillation. This may occur in almost half of patients who receive the surgery. Other serious complications include bleeding, infections, blood clots, changes in heart rhythm, fluid buildup in the chest, pneumonia, and loss of lung function. Again, these become more common with more severe mesothelioma cases.

The main complications of P/D are hemorrhage and prolonged air leak. However, similar to EPP, complications with the heart, lungs, kidneys and liver may also occur. Since patients are asleep during these procedures, they also face rare risks that come with anesthesia, including asphyxiation and allergic reactions.

In addition to complications that may occur due to the difficulty of this type of cancer, human error is also always a factor in surgery. Things such as lack of experience, miscommunication, and fatigue may lead to certain complications in any area of medicine, not just surgery.

How Can Complications Be Minimized?

Surgery is offered only to those who are healthy enough to overcome the physical demands of surgery. The choice of an operation is based on specific patient characteristics, and the severity and type of cancer involved. By being selective with who can receive surgery, surgeons can try to identify patients who may be at higher risk for complications.

Surgical procedures are also limited to those who have “early mesothelioma.” This means that the tumor or tumors have been discovered at an early stage and more options for treatment are possible.

There is no single ideal type of surgery. Regardless of the type of surgery one’s doctor may choose for him or her, one thing is clear: surgery is contributing greatly to the medical world’s understanding of pleural mesothelioma. World-renowned mesothelioma specialist and Director of the Lung Institute at Baylor College of Medicine, Dr. Sugarbaker, has stated, “Surgery has contributed immensely to our improved understanding of the biology of mesothelioma.”

The choice to undergo surgery, of course, is made together with the surgeon and the patient and his/her family. It is based on what part of the body the cancer affects, how long a patient has had cancer, a patient’s medical history, and potential for complications. All patients will respond differently to surgery, and an open relationship between patient and doctor is key to the best possible results.