Surgery

Surgery for Varied Reasons

Surgery may be performed on mesothelioma patients for different reasons.  Because mesothelioma is difficult to diagnose, surgery is often undertaken to remove tissue samples from the area that may be cancerous.  This type of surgery is called a biopsy, and results in tissue samples being examined by a pathologist.

Surgery may also be performed on mesothelioma patients to relieve symptoms associated with the disease in order to improve a patient’s quality of life.  It also may be performed to improve survival in a small number of patients.  The extent of the cancer’s spread throughout the body is the key factor in arriving at an informed medical decision relating to appropriate treatment.  Mesothelioma is like most cancers – if it is diagnosed at its early stages, the outlook is usually better.  Generally, if the mesothelioma is localized on the pleura (in cases of pleural mesothelioma) or the peritoneum (in cases of peritoneal mesothelioma), then the disease in its early stages.  This is why if you or a loved one has a history of occupational exposure to asbestos, it is sound practice to schedule regular appointments with your physician.

Pleurectomy or Decortication

Patients with mesothelioma often experience chest pain.  They also have difficulty breathing and experience shortness of breath.  These symptoms are typically caused by the build up of excess fluid around the lungs and the chest.  When mesothelioma is detected in its early stages, some patients may be viable candidates for a pleurectomy.  This surgical procedure involves the opening of the chest and the removal of parts of the pleura or the peritoneal lining where the tumor is located, along with some the surrounding tissue.

Many times a pleurectomy is performed in conjunction with a decortication (the surgical removal of the membrane of an organ).  The chief surgical goal of a pleurectomy is to extract the tumor (or at least parts of the tumor), and yet leave the lungs largely intact and unaffected.  A pleurectomy aims to control the accumulation of fluid in the lungs or chest and reduce pain.  It is mainly considered palliative, in that it decreases pain and improves mobility, but does not cure the patient of cancer.

Unfortunately, the aggressive tumor is usually not completely removed following a pleurectomy.  Radiation is a treatment option for patients with mesothelioma, however, with a pleurectomy; doctors cannot administer high deses of radiation to the chest.  This is because serious damage to the lungs and diaphragm could result.  Without the administration of a regimen of radiation therapy, the tumor has a much higher degree of recurrence following a pleurectomy, as compared to, for example, more invasive surgery to remove the entire lung.  The radical surgical option to treat mesothelioma is called an extrapleural pneumonectomy (EPP) and is more fully detailed below.  This surgery strives to remove the entire tumor from the body.  For physically weak patients, doctors will often perform a pleurectomy/decortication because it can be tolerated by the patient and has a low mortality rate compared to the EPP.

Extrapleural Pneumonectomy

Extrapleural pneumonectomy, or EPP, is an invasive surgery that removes portions of the lung, or the lining of the lung.  EPP surgery seeks is to extract the complete mesothelioma tumor.  A thoracic surgeon performs the surgery.  The thoracic surgeon’s efforts will ideally remove the maximum number of tumor cells.  Oftentimes, the surgeon removes the entire lung and the affected lymph nodes.  EPP is generally performed in the early stages of mesothelioma.  A patient must be in good physical shape and have sound heart and lung functioning to withstand the rigors of EPP.  EPP is followed by an extensive combination of chemotherapy and radiation.

Recovery from EPP is long and painful.  Major complications can arise.  Although, medical advances have been made, only few patients ultimately benefit significantly from the complex surgery.  However, if your doctor informs you that you are a viable candidate for EPP surgery, it offers you the best chance for complete removal of the tumor.  Given the complicated nature of the surgery, consult your medical team so you are fully informed about EPP’s risks and benefits.