Malignant Mesothelioma Surgery

Surgery

Surgery for pleural mesothelioma may be done for 1 of 2 reasons: to relieve pain and discomfort caused by the tumor (called palliation) or to cure.

Palliative surgery is typically done in cases where the tumor has already spread beyond the mesothelium and is difficult to remove completely, or if you are too ill to tolerate a more extensive operation.

Curative surgery is offered if you are in otherwise good health and the tumor is thought to be localized and can be removed completely. Unfortunately, the cancer cells tend to spread into the chest wall, around the heart, over nerves, and the diaphragm. It is often difficult to detect this spread. Because of this, doctors are not clear on the exact role of surgery. It is not likely to cure you but may extend your life. Curative surgery is being done in some cancer centers and a few of the patients who have had the surgery are experiencing long remissions of their disease.

Depending on the stage of a mesothelioma, surgery may be used to remove the cancer and some of the surrounding tissue. Often, however, an operation is not appropriate and you may have only smaller procedures to relieve symptoms.

A thoracentesis, where fluid in the chest is removed by placing a needle into the chest cavity, may be done to make a patient more comfortable. Sometimes talc or drugs that cause scarring may be injected into the chest cavity to try to prevent the fluid from returning. This is called pleurodesis. These techniques are successful in controlling the fluid, at least temporarily, in as many as 90% of patients. Because pleural fluid can compress the lung and cause shortness of breath, these procedures can help you breathe more easily, however, they do not cure the cancer.

In the case of peritoneal mesothelioma, a needle may be inserted into the abdomen to drain the fluid. Similarly, a needle inserted into the pericardium (sac around the heart) can drain pericardial fluid and help relieve circulatory problems. Sometimes the cancer cells spread along the needle path, and a tumor nodule may form under the skin of that area. This concern should not prevent fluid removal, though.

Two surgical procedures may be offered if you have pleural mesothelioma: pleurectomy/decortication and extrapleural pneumonectomy.

Pleurectomy/decortication: Pleurectomy/decortication is usually a palliative procedure (relieves symptoms without curing the cancer) in cases where the entire tumor cannot be removed. This procedure removes the pleura, where the majority of the tumor is located. It can control the build up of fluid improve breathing and decrease pain caused by the cancer.

Extrapleural pneumonectomy: Extrapleural pneumonectomy is a far more extensive operation and is most often used in patients with localized mesothelioma of the epithelioid type, when the surgeon thinks a cure is possible. It is a difficult operation and is done only by surgeons in large specialized medical centers. You should talk with your doctor about an appropriate treatment center nearest to your home. The operation removes the pleura lining the chest wall, diaphragm, pericardium, and the whole lung on the side of the tumor. The diaphragm and the pericardium are then reconstructed with prosthetic material. You must be in overall good health with no other serious illnesses to tolerate the surgery. This operation attempts to remove all or most of the cancer and some surrounding tissues as well.

Surgical treatment of peritoneal mesothelioma is often done either to help relieve symptoms or to remove the tumor from the wall of the abdomen and other digestive organs. As with pleural mesothelioma, these tumors are often too extensive to remove completely. Similar operations can be done to remove a mesothelioma from the pericardium (the sac around the heart).

Surgery for mesothelioma of the tunica vaginalis testis, which occurs in the groin, is also not usually curative. Most of the time surgery is done because the tumor resembles a hernia. The surgeon attempts to treat a suspected hernia and only realizes the diagnosis after the surgery is begun. This kind of mesothelioma can’t be entirely removed.