Mesothelioma Surgery Side Effects

Quick Summary

In many cases, mesothelioma patients are good candidates for palliative or curative surgery. However, it’s important to carefully consider the potential surgery side effects and risk factors with your mesothelioma specialist while determining a treatment plan.

General Risks and Side Effects of Surgery

The risks and side effects of any cancer surgery vary from patient to patient depending on the following factors:

  • Patient’s age and overall general health
  • Disease location
  • Disease stage
  • Type of surgery

Mesothelioma is a difficult cancer that requires an extensive surgery. While only the most experienced oncological surgeons perform mesothelioma surgery, it is crucial that patients understand the high-risk nature involved with operating on and near vital organs.

The general risks and side effects of any major surgery may include:

  • Pain at the site of operation
  • Blood clotting
  • Bleeding (internal or external bleeding, normally controlled)
  • Damage to nearby tissue and organs
  • Infections (at the incision site or internally at the site of operation)
  • Pneumonia

As mesothelioma surgeries are performed under general anesthesia (inhaled or administered by IV), patients may experience these short-term side effects:

  • Nausea, vomiting, and dizziness
  • Chills
  • Temporary confusion
  • Sore throat (from removal of the breathing tube)
  • Muscle discomfort
  • Itching

In rare cases, the following serious risks may arise due to general anesthesia:

  • Malignant Hyperthermia: (a rare but potentially fatal reaction to anesthesia during surgery causing rapid fever)
  • Delirium: (confusion, disorientation and difficulty with memory recall, occurring up to a week after surgery)
  • Cognitive Dysfunction: (patients with some existing medical issues including heart and lung disease, Alzheimer’s and Parkinson’s disease may be at increased risk for long-term memory loss and impairment to learning ability)

Surgery Update

As with any surgery, your medical team will take all possible precaution in reducing the risks and the severity of side effects. Read the section below on Minimizing Mesothelioma Surgery Risks for more information.

Possible Risks and Side Effects by Mesothelioma Surgery Type

No two mesothelioma patients are alike, making the potential surgery risks and side effects different for each case.

Still, there are specific risks associated with each type of mesothelioma surgery of which to be aware:

Extrapleural Pneumonectomy (EPP)

Extrapleural pneumonectomy (EPP) surgery is most often performed for patients with early stages of pleural mesothelioma. For EPP, open surgery is involved, with the affected lung completely removed along with the lining of the lung (pleura), the lining of the heart (pericardium), nearby lymph nodes and a portion of the diaphragm.

By removing the entire lung, EPP offers patients the greatest probability of mitigating recurrence. Lung removal also carries increased risks and therefore presents the highest chance of complication of all mesothelioma surgeries, such as respiratory failure, pulmonary embolism and cardiac arrest or other issues related to the heart.

Up to 33% of EPP patients experience a complication.

You must also consider the effect that living with one lung will have on your quality of life.  Otherwise healthy patients often live a normal, high-functioning life with a single lung. However, some patients experience shortness of breath and difficulty breathing, and in some cases, they may need an oxygen tank after surgery.

When a lung is removed, the body’s other organs shift into the newly vacant space. In most cases, this causes no serious complication. However, in very rare cases post-pneumonectomy syndrome may occur, resulting in obstruction to the airways.

Pleurectomy with Decortication (P/D)

The second surgery option for pleural mesothelioma is pleurectomy with decortication (P/D). This surgery spares the cancerous lung. Instead, the surgeon performs pleurectomy (removal of the affected lung lining) and decortication (removal of tumors).

Since P/D allows the patient to keep the affected lung, fewer complications are likely to arise during the operation and in recovery. Many of the risks associated with EPP are also risks for P/D surgery but at a lower rate. It should be noted that P/D surgery is a much longer procedure than EPP, raising the potential for risks associated with general anesthesia to arise during or after the operation.

Cytoreduction With HIPEC

For many patients with peritoneal mesothelioma, cytoreduction surgery is the best treatment option. Cytoreduction involves peritonectomy (removal of the abdominal lining) along with any visible tumors.

Many peritoneal mesothelioma patients will also undergo hyperthermic intraoperative chemotherapy (HIPEC), a heated chemotherapy treatment applied to the abdominal cavity during surgery.

Potential risks are lower for cytoreduction than with other types of mesothelioma surgery. Still, general surgical risks and side effects remain. Some cytoreduction patients experience complications to the digestive system as well as pulmonary issues such as pneumonia.

Mortality Rates of Mesothelioma Surgery

Each type of mesothelioma surgery has its risk factors, with the patient’s specific case also contributing to the outcome of the surgery.

The following are general statistics associated with each mesothelioma surgery:

  • Extrapleural Pneumonectomy: 3–8% mortality rate
  • Pleurectomy/Decortication: 1–4% mortality rate
  • Cytoreduction With HIPEC: 1–5% mortality rate

Be sure to seek a second opinion from a mesothelioma specialist before deciding on any surgery or treatment plan.

Mesothelioma Surgery Recovery

Mesothelioma surgery is extensive and therefore the postoperative recovery period is considerable:

  • Extrapleural Pneumonectomy: Approximately two weeks’ hospital stay, with six to eight weeks’ recovery at home
  • Pleurectomy/Decortication: Approximately one-week hospital stay, with two to four weeks’ recovery at home
  • Cytoreduction With HIPEC: Approximately one-week hospital stay, with two-four weeks’ recovery at home

Directly following surgery, the medical team observes patients with possible complications and monitors their vital signs carefully. Patients usually use a respirator for the first few days to aid with breathing, and an IV administers medication and fluids. Patients will feel some pain in the area of operation, though painkillers can be provided.

The recovery of bodily functions can be a slow process. Physiotherapy and breathing exercises are especially important for pleural mesothelioma patients, and these may begin soon after the surgery.

The digestive system may also be slow in recovering, particularly for peritoneal mesothelioma patients following cytoreduction.

The recovery period for extrapleural pneumonectomy may differ for each patient and how the body reacts to the removal of a lung. Patients will likely experience shortness of breath for anywhere from weeks to months. Ample rest is critical following extrapleural pneumonectomy.

Minimizing Mesothelioma Surgery Risks

Mesothelioma specialists continue to make advancements in curative and palliative surgery, with success rates rising and mortality rates falling.

Determining the correct treatment plan for each patient is essential in minimizing risks associated with mesothelioma surgery. To start, only patients who are healthy enough to undergo an extensive operation will be considered eligible for mesothelioma surgery.

The surgeon will then consider several factors when recommending treatment, including the mesothelioma stage and location. A particular diet or exercise regime may be prescribed ahead of the surgery to ensure your body is well prepared.

For pleural mesothelioma surgery, there is debate among medical professionals as to whether extrapleural pneumonectomy or pleurectomy with decortication is the most effective treatment. Some patients may be able to live a high-quality life with only one lung, while other patients might see greater benefit from sparing the lung.

Each mesothelioma case is unique. Therefore, it is critical to consider the benefits as well as the potential risks of surgery when deciding a treatment plan. Mesothelioma specialists are available to help you weigh the options.

Contact a Mesothelioma Help Now Patient Advocate for more information and to connect with a top mesothelioma specialist in determining the right treatment plan for you.

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Sources
  1. American Cancer Society, “Risks of Cancer Surgery.” Retrieved from: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery/risks-of-cancer-surgery.html. Accessed on January 14, 2018.
  2. American Cancer Society, “Surgery for Malignant Mesothelioma.” Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/treating/surgery.html. Accessed on January 14, 2018.
  3. American Society for Anesthesiologists, “Effects of Anesthesia.” Retrieved from https://www.asahq.org/whensecondscount/patients%20home/preparing%20for%20surgery/effects%20of%20anesthesia. Accessed on January 14, 2018.
  4. Indian Journal of Surgical Oncology, “Complications of Cytoreductive Surgery and HIPEC.” Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818615. Accessed on January 14, 2018.
  5. The Journal of Thoracic and Cardiovascular Surgery, “Postpneumonectomy Syndrome.” Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/18544355. Accessed on January 14, 2018.

Last modified: May 7, 2018