Surgery for Mesothelioma Treatment
In the early stages of mesothelioma, the cancer has not spread far from its point of origin. During these stages, it may be resectable which means it can be treated with surgery. When surgery is performed with intent to remove all of the cancerous cells, it is called curative. Curative surgery for mesothelioma is typically a major invasive procedure and could involve removal of all or part of an organ. Curative surgery is not always successful, but it typically does prolong the survival rate in patients. In some cases, curative surgery may create further complications for patients. Palliative surgery is used to relieve symptoms or improve the quality of life but there is no expectation of a cure.
Curative Surgeries
Pleurectomy/Decortication for Pleural Mesothelioma
Patients with Stage 1 or Stage 2 pleural mesothelioma may be candidates for a pleurectomy/decortication. During this surgical treatment, first the infected parts of the pleura are removed (pleurectomy). Then, part of the lung’s surface layer is removed to permit full lung expansion.1
A radical pleurectomy/decortication is when all of the pleura are removed. A non-radical pleurectomy/decortication is when up to 70% of the pleura are removed. One study showed that radical pleurectomy/decortication is associated with a much higher survival rate compared to non-radical surgery: approximately 17.2 months versus 8.1 months. Patients who did not undergo any surgery have a survival rate of 6.8 months.
While a radical pleurectomy/decortication does increase survival rate, the process has serious risks including a mortality rate of approximately 55%. Breathing complications may also occur as a result of the procedure.
Extrapleural Pneumonectomy
Extrapleural pneumonectomy is a surgical procedure in which infected areas of the lung, chest cavity, heart lining, diaphragm, and/or lymph nodes are removed. In most cases, the surgery is performed solely for treating pleural mesothelioma. In order for this surgery to be performed, it is crucial that the mesothelioma has not spread to both lungs as, in some cases, the entire infected lung may need to be removed.
An extrapleural pneumonectomy can be performed for curative or palliative reasons. Curatively, it has been shown to increase the lifespan of patients significantly. The surgery may also be used along with radiation or chemotherapy treatments. Extrapleural pneumonectomy can also reduce symptoms of mesothelioma, particularly improving breathing.
Extrapleural pneumonectomy is a serious surgical procedure and comes with risks of complications. The recovery time from the surgery is also long, usually lasting a minimum of six weeks.
Cytoreductive Surgery
Cytoreductive surgery, also called debulking, may be used curatively during the early stages peritoneal mesothelioma. During the surgery, a surgeon attempts to remove all or most of the cancer found in the abdominal area. The surgery is then followed up by chemotherapy to destroy remaining mesothelioma cells. One study published in the 2009 in the European Journal of Surgical Oncology showed that complete cytoreduction surgery combined with chemotherapy could significantly improve prognosis; patients survived a mean of 3.7 years. Patients who underwent a palliative cytoreduction and chemotherapy had a mean survival rate of 1 year.
There are certain factors that will improve the prognosis or survival period when cytoreductive surgery is used:2
- Subtype of the epithelial
- No metastasis in the lymph nodes
- Completeness of CC-0 or CC-1 cytoreduction scores
- Completeness of HIPEC cytoreduction scores
Palliative Surgeries
Pleurodesis
Pleurodesis surgery is performed on patients with pleural mesothelioma. Its goal is to reduce fluids which can build up in between the lungs and pleura (pleural effusion). To do this, surgeons will first remove the fluids with a tube. Then, surgeons will fuse the sides of the emptied space together so that it cannot become filled with fluids again.3
Thoracotomy
A thoracotomy is a serious surgical procedure in which parts of the lungs are removed. The goal of the surgery is to remove as much of the infected areas as possible while leaving the most amount of healthy tissue possible. There are several types of thoracotomy which are primarily differentiated by how much and what type of lung tissue they remove.
Paracentesis
Peritoneal mesothelioma can lead to a buildup of fluids in the abdominal area. The fluids, called ascites, can lead to various symptoms and complications such as pain, bowel problems, and interference with the digestive system. The goal of a paracentesis surgery is to remove the built-up fluid. To do this, a doctor will insert a hollow needle into the abdominal area and the fluid will slowly be drained. This process can take up to several days. Paracentesis is considered a safe procedure though it does cause patients discomfort.
References
1 The E., Fiorentiono F., Tan C. and Treasure T. (Feb 2011) A systematic review of lung sparing extirpative surgery for pleural mesothelioma. J R Soc Med, v104:2, 69-80.
2 Yan, Tristan D, Marcello Deraco, Dario Baratti, Shigeki Kusamura, Dominique Elias, Olivier Glehen, François N. Gilly, Edward A. Levine,Perry Shen, Faheez Mohamed, Brendan J. Moran, David L. Morris,Terence C. Chua, Pompiliu Piso and Paul H. Sugarbaker. (20 December 2009) Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma: Multi-Institutional Experience, v27:36, 6237-6242.
3 Treatment Option Overview (2011) Retrieved from National Cancer Institute at: http://www.cancer.gov/cancertopics/pdq/treatment/malignantmesothelioma/patient/page4#Keypoint15
