Mesothelioma Surgery

Quick Summary

Surgery is an important treatment option for mesothelioma patients. All mesothelioma locations have specialized surgical procedures that can remove tumors and diseased organs and tissues. Depending on how advanced your condition is, you may be eligible for potentially curative surgery.

Mesothelioma Surgery Overview

If you’ve been diagnosed with mesothelioma, your doctor will likely review surgical options with you based on what he or she feels will give you the best chance at longer-term survival.

Here is what all mesothelioma patients should know about their surgery options:

  • Surgery is the best way to increase life expectancy in mesothelioma patients
  • Mesothelioma surgery is a critical option in multimodal therapies which combine chemotherapy and radiation
  • Surgery can either be curative (removing all visible signs of mesothelioma) or palliative (improving quality of life)
  • Curative surgeries are typically performed on stage 1 and 2 mesothelioma patients
  • Surgery options exist for every mesothelioma location and cell type
  • Mesothelioma specialists across the country are available to perform life-extending surgeries now

Mesothelioma Surgery Treatment Goals

There are a few standard surgical procedures for mesothelioma, and each one accomplishes different goals. Doctors decide which treatment options to pursue based on several factors and the outcomes they hope to achieve.

In some cases, doctors perform aggressive surgeries with the goal of eliminating mesothelioma and sending the patient into remission. Other times, doctors perform palliative surgeries to make the patient as comfortable as possible.

Some of the treatment goals of different surgeries include:

  • Removing all visible signs of tumors
  • Debulking tumors, though not removing them entirely
  • Removing diseased organs and tissues
  • Alleviating fluid buildup and relieving pressure

The primary difference between different surgical treatment goals is whether or not the surgery intends to be curative or palliative.

Curative vs. Palliative Surgeries for Mesothelioma

Doctors review each patient case and determine the best treatment options possible that will improve life expectancy and quality of life while reducing risks of surgical complications. Early-stage mesothelioma patients are almost always eligible for curative surgeries.

Because the mesothelioma hasn’t metastasized (spread) too far beyond its primary location in stage 1, doctors can surgically remove tumors, then follow up with chemotherapy and/or radiation therapy to kill any remaining mesothelioma cells left behind.

In late-stage mesothelioma patients, the mesothelioma has metastasized significantly into other tissues or organs. Having cancer spread so far to distant sites makes it virtually impossible for surgeons to remove all of the tumors, and instead, they shift to palliative surgeries.

With palliative surgeries, doctors may focus on debulking the tumors, meaning they remove as much as possible. Or they may remove diseased tissues and organs and drain fluid buildup to help relieve painful symptoms.

Surgery Options by Mesothelioma Location

Each mesothelioma location and stage has its own standard surgical options. Different surgeons specialize in different areas of the body, meaning some can only treat certain types of mesothelioma.

A surgeon who specializes in treating pleural and pericardial mesothelioma is a cardiothoracic surgeon. A surgeon who specializes in treating peritoneal mesothelioma is a gastrointestinal surgeon.

Among each of these specializations, certain surgeons only specialize in early stage mesothelioma, while others may be experienced in treating late-stage mesothelioma.

Pleural Mesothelioma Surgery Options

For pleural mesothelioma patients, there are two standard surgical options. Both are considered curative surgeries, yet follow different philosophies. There is debate in the mesothelioma treatment community about which surgical option is better for a patient’s long-term survival.

While it may be a contentious issue, there’s no debate over the fact that both of these surgeries can increase life expectancy in stage 1 and 2 pleural mesothelioma patients.

The two primary pleural mesothelioma surgery options are:

Extrapleural Pneumonectomy

Developed by the late Dr. David Sugarbaker for pleural mesothelioma, the extrapleural pneumonectomy is an aggressive surgery that costs the patient their lung but can save their life.

During an extrapleural pneumonectomy, the surgeon removes:

  • The affected lung on the side of the chest where the tumor first began
  • The pleura (lung lining)
  • Part of the pericardium (heart lining)
  • Part of the diaphragm
  • Nearby lymph nodes

For stage 1 and 2 pleural mesothelioma patients who are healthy enough to undergo this surgery, an EPP can extend their life.

Different studies have shown that the EPP can increase a patient’s life expectancy to 27-36 months, which is higher than the median life expectancy of 12-21 months. Some patients have survived 5 years or longer after an EPP and some remain cancer-free today.

Pleurectomy with Decortication

Developed by Dr. Robert Cameron as an alternative to the EPP, the pleurectomy with decortication (P/D) is a lung-sparing pleural mesothelioma surgery. During a P/D, the surgeon removes the diseased pleura and all visible tumors around the surgical site.

The surgeon removes both pleura lining layers, called the parietal (outer) and the visceral (inner) layers. Depending on how far the tumor has spread, the surgeon may remove some of the lung tissues as well. P/D can increase life expectancy in stage 1 and 2 mesothelioma patients. As with EPP, different studies have produced different results.

Generally, patients who undergo P/D have a life expectancy of around 20 months. The primary difference that doctors are concerned with between the P/D and the EPP is the lower risks of fatal complications associated with the P/D.

Peritoneal Mesothelioma Surgery Options

Peritoneal mesothelioma has the best prognosis compared to other mesothelioma locations thanks in large part to the effectiveness of its standard surgical treatment.

The abdomen is safer to operate on than the lungs and heart, so peritoneal mesothelioma patients have lower risks of surgical complications.

As with all mesothelioms, the sooner patients undergo treatments the better. Early-stage peritoneal mesothelioma patients are usually excellent candidates for curative surgeries.

The primary surgical option for peritoneal mesothelioma is:

Cytoreduction with HIPEC

Coined “The Sugarbaker Technique” after its developer, Dr. Paul Sugarbaker, cytoreduction with HIPEC is a potentially curative surgery option for peritoneal mesothelioma patients.

The 2 parts to this procedure are:

  1. Cytoreduction: The surgeon opens up the abdominal cavity and surgically removing the peritoneum (abdominal lining) and all visible tumors. Depending on how advanced the case is, cytoreduction surgery can either be considered complete or incomplete depending on how much of the tumor can be removed.
  2. HIPEC: The doctors administer HIPEC—chemotherapy drugs applied directly into the peritoneum right after surgery. Chemotherapy drugs are heated to increase their effectiveness and are left to bathe the entire abdominal cavity in these anticancer therapies.

Surgery Upate

The goal of HIPEC is to kill off remaining cancer cells through direct administration, as opposed to conventional chemotherapy administered into the bloodstream. Cytoreduction with HIPEC has shown to improve survival time to over 87 months in peritoneal mesothelioma patients.

Pericardial Mesothelioma Surgery Options

Pericardial mesothelioma patients are rarely eligible for aggressive surgery because of how far advanced the condition is at diagnosis. However, in cases where the condition is detected early enough, pericardial mesothelioma patients have one important surgical option.

Pericardiectomy

The pericardiectomy is a surgical procedure performed in pericardial mesothelioma patients who are healthy enough to undergo this risky procedure. During a pericardiectomy, the cardiac surgeon removes the diseased pericardium (heart lining) and any tumors he or she can find nearby.

Pericardiectomy is rarely seen as a curative surgery and is generally performed to help alleviate chest pain and other symptoms. However, there have been cases where patients who have undergone a pericardiectomy have survived 2 years thanks to this aggressive surgery.

Mesothelioma Surgery Side Effects

Though mesothelioma patients can improve their survival times by undergoing aggressive surgeries, there are also risks involved.

All patients are encouraged to have an open conversation with their surgeon about the realities of surgery. Any time surgery is performed there are risks involved, and surgeries that operate so close to the lungs and heart do carry higher risks.

For example, the EPP can result in complications such as hemorrhaging, heartbeat irregularities and fluid buildup in the remaining lung. The P/D can result in complications such as air leakage from the lung (pneumothorax), blood clots and difficulty breathing.

Both procedures have a certain mortality rate, with the EPP mortality rate being higher than the P/D. Although, experts have found that EPP mortality rates have dropped significantly in recent years due to doctors perfecting the procedure.

Some other possible surgical side effects are to be expected. Common surgical side effects include swelling, bruising and drainage. Surgeons monitor patients closely after surgery and look for any changes in their condition. If negative changes occur, doctors respond by administering other treatments or medications. However, mesothelioma surgeons anticipate side effects and do their best to mitigate these from the beginning.

Get Treated By the Top Mesothelioma Surgeons

If you’ve been diagnosed with mesothelioma, then it’s important to see any one of the top mesothelioma surgeons here in the United States. Mesothelioma specialists are dedicated and committed experts who have contributed significantly to the research and development of life-extending mesothelioma surgeries.

By working with a specialist, you can rest assured that you have been given the most effective surgical treatment options available.

Specialists can help you to have a solid understanding of what treatment options are available to you, including aggressive surgeries. Be sure to review all possible surgical options with your team of specialists to decide on the best approach for you.

Contact Mesothelioma Help Now today to learn more about working with top mesothelioma surgeons near you.

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Sources
  1. Cancer Research UK, “Mesothelioma: Surgery” Retrieved from: http://www.cancerresearchuk.org/about-cancer/mesothelioma/treatment/surgery/. Accessed on December 26, 2017.
  2. American Cancer Society, “Surgery for Malignant Mesothelioma”, Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/treating/surgery.html. Accessed on December 26, 2017.
  3. Medscape, “Surgery for Malignant Pleural Mesothelioma” Retrieved from: https://www.medscape.com/viewarticle/724140. Accessed on December 26, 2017.

Last modified: October 24, 2018