Surgery is the most common treatment method for patients with mesothelioma. It is often used in combination with radiation treatments and chemotherapy to improve life expectancy or improve quality of life.
Only about 3,000 new mesothelioma cases are diagnosed each year but this asbestos-related cancer is highly aggressive and commonly has a poor prognosis. Surgery can be a successful treatment method, particularly when used at earlier stages and when combined with radiation and / or chemotherapy.
Surgery at Different Mesothelioma Stages
Surgery is one of three major treatment options for mesothelioma patients. When used in earlier stages, it may help to increase life expectancy, particularly if combined with other treatments. In later stages, surgery may help to reduce symptom severity and improve quality of life.
Surgery for mesothelioma may be considered “curative” or “palliative”. Curative surgery is performed to increase life expectancy and improve survival rates. Palliative surgeries are used to reduce pain and relieve symptoms and improve patient comfort and quality of life.
Curative surgeries are used during earlier stages to increase life expectancy and improve survival rates. When used along with other treatment methods, it may dramatically improve a patient’s prognosis. The type of surgery performed will depend on the location and type of mesothelioma, along with the stage of cancer, and other specific characteristics.
Curative surgeries for mesothelioma may include:
Cytoreduction – cytoreduction involves the removal of the peritoneal lining of the abdomen including removal of tumors which have grown on the mesothelium. Cytoreduction can be performed at any stage of peritoneal mesothelioma but in later stages would be considered a palliative treatment.
It is sometimes used in combination with heated intraoperative chemotherapy (HIPEC) which involves the direct application of heated chemotherapeutic medication to “wash out” the peritoneal cavity. When performed in earlier stages, cytoreduction can increase life expectancy by three or more times and cytoreduction with HIPEC may increase the life expectancy even when used in later stages but not all patients will be able to undergo the procedure.
Pleurectomy / Decortication (P/D) – decortication involves the removal of layer of fibrous tissue surrounding the lung which may have become thickened and stiff, restricting lung expansion. Pleurectomy involves removal of the pleural layer surrounding the lungs. A pleurectomy / decortication procedure removes all of the pleural tissue including tumors and other tissue which have grown in the mesothelium.
P/D procedures are most commonly performed in early stages and it is often used in combination with chemotherapy and radiation treatments. Newer treatment methods also employ intraoperative radiation therapy (IORT) which involves radiotherapy during the surgery. This method is often more effective as radiation is applied directly to cancerous tissue. P/D also reduces the chance of pleural effusion or the buildup of fluid in the lining surrounding the lungs which can cause lung compression and difficulty breathing.
Extrapleural Pneumonectomy (EPP) – extrapleural pneumonectomy involves the removal of the entire lung and pleural lining on the side which has developed mesothelioma. The EPP is a radical and invasive surgery intended to remove all cancerous material.
EPP is most commonly used in early stages and may be in conjunction with intensity-modulated radiotherapy (IMRT) which is highly concentrated radiation therapy, intended to kill cancer cells. IMRT may be performed before or after surgery to ensure that all cancer cells are killed and removed. In some cases, this may keep cancer from spreading and may extend life expectancy by a significant amount but it is highly invasive and not appropriate for all patients.
Pericardectomy – pericardectomy involves the removal of the pericardial sac surrounding the heart including tumors which have developed on the mesothelium. Pericardectomy may help to relieve cardiac compression. Pericardial mesothelioma accounts for only 1 percent of mesothelioma cases and this type of cancer is not often detected until later stages. Though pericardectomy may extend life expectancy when used in early stages, in later stages, the surgery may not be appropriate for most patients.
Palliative mesothelioma surgeries are performed to reduce severity of symptoms, relieve pain and increase patient quality of life. They are not intended to be life-extending but in some cases may improve patient prognosis somewhat.
Many palliative surgeries are intended to relieve fluid buildup surrounding organs. This excessive fluid may produce pressure and make breathing, digestion or heart contractions painful or difficult.
Thoracentesis – thoracentesis is used to drain fluid buildup in the space surrounding the lungs. It is performed with a needle and may relieve pressure on the lungs, making breathing easier.
Paracentesis – paracentesis is used to drain fluid buildup in the abdominal cavity, known as ascites. It is performed with a needle and may relieve pressure on the intestines and diaphragm as well as increasing patient comfort.
Pericardiocentesis – pericardiocentesis is used to drain fluid buildup within the pericardial sac surrounding the heart. It is performed with a needle and may relieve pressure on the heart, making heart contraction more efficient. As the heart beats more efficiently, swelling and discomfort in other areas of the body may subside.
Pleurodesis – pleurodesis is a procedure used to “fuse” tissues together, eliminating the pleural space surrounding the lungs. It is performed with the injection of an irritating medication and will eliminate the possibility of future pleural fluid buildup.
Surgery is a mainstay of mesothelioma treatment but it may not be appropriate for every patient. Factors which determine whether surgery will be effective or useful may include:
- Type of mesothelioma
- Location of tumors
- Stage of disease
- Health of the patient
- How far cancer has spread
Each type of surgery carries risks and may pose challenges with regard to anesthesia, surgical time and recovery time. Patients and family members should be aware of the risks and potential benefits to each type of treatment.
- Dr. David Sugarbaker
- Focus: Pleural Mesothelioma
- Dr. Paul Sugarbaker
- Focus: Peritoneal Mesothelioma
- Dr. Robert B. Cameron
- Focus: Pleural Mesothelioma
Mesothelioma is such a rare type of cancer that many physicians, oncologists or surgeons have not had experience in treating the disease. It is important that patients diagnosed with mesothelioma seek advice or treatment from a mesothelioma specialist.
Surgery may improve a patient’s prognosis and life expectancy, particularly if used in early stages and in combination with other treatments. Each patient is unique and a mesothelioma specialist will be able to ensure that all treatment options are considered. In some cases, surgery combined with multimodal therapy can increase the life span for many months or even years beyond expectations.
Mesothelioma specialists may also be involved in conducting investigational studies or clinical trials which may provide an opportunity for patients to receive advanced surgical or other types of treatments.