Surgery for Mesothelioma
Though there is no know cure for mesothelioma, there are a few treatment methods
that can alleviate some suffering or extend the life. Different treatment methods
are suggested for different types of mesothelioma.
Surgery for pleural mesothelioma
Pleural mesothelioma usually affects one lung before the other and this allow doctors to try various procedures. There are two general types of surgical treatment for pleural mesothelioma - Palliative surgery and Curative surgery.Palliative surgery - When the tumor has already spread beyond the mesothelium and is difficult to remove completely, Palliative surgery is recommended. It is also done if the patient is too ill to tolerate a more extensive operation. Palliative surgery does not cure the patient, but help control symptoms of the disease. Pleurectomy/Decortication and Pneumonectomy are examples of palliative surgery.
Curative surgery - This surgery is typically done if the patient is in good health and 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 and it is often difficult to detect this spread. Because of this, the exact role of surgery is often debated. Though this surgery is performed with curative intent, it can't eradicate malignant mesothelioma. Even highly involved surgical procedures such as Extrapleural Pneumonectomy are not able to save the life of a mesothelioma patient. Anyway, curative surgery has proven to be effective in significantly increasing survival rates. It has increased the survival time as much as five years which is more than two times the average survival time. Extrapleural Pneumonectomy is a curative surgery.
There are mainly four types of surgery for treating pleural mesothelioma - Pleurectomy/Decortication, Pneumonectomy, Thoracentesis and Extrapleural Pneumonectomy.
Pleurectomy/Decortication
This is a type of palliative surgery in which part of the lining of the chest and some of the tissues around it are removed. This treatment reduces chest wall pain. It also helps to prevent fluid from forming in the affected area. However, according to statistics, no increase in survival rate can be expected with this procedure.
Pneumonectomy
Another palliative surgery which is the same as pleurectomy with the additional removal of the lung. This method also is not helpful to increase the survival rate.
Thoracentesis
Thoracentesis can be considered as a diagnostic or a palliative surgery. The fluid in the chest is removed by placing a needle into the chest cavity. Because pleural fluid can compress the lung and cause shortness of breath, this treatment method is helpful to improve the ability to breathe.
Extrapleural Pneumonectomy
This is a far more extensive operation and considered as a curative surgery. It is often used in patients with localized mesothelioma of the epithelioid type, when the surgeon thinks a cure is possible. To tolerate this surgery, the patient should be in overall good health with no other serious illnesses. EPP is suitable only if the cancer is at an early stage. If it has spread to lymph nodes, or is growing into any other major body parts outside the lung, this surgery is not suitable. It is a complicated operation and is done only by surgeons in large specialized medical centers. This operation removes the pleura lining the chest wall, diaphragm, pericardium, and the whole lung on the side of the tumor. That is, almost all the cancer and also some surrounding tissues are removed.In EPP, the surgeon opens the patient's chest, either at the front or at the side. An opening at the side is called a thoracotomy and that at the front is called a sternotomy. It creates a wound about 9 inches deep. The patient has to stay in hospital for about 2 weeks after the surgery. It may take approximately 6 to 8 weeks to recover fully.
Though EPP can't cure mesothelioma, it extends the life of patient. The people who have lived maximum after diagnosed with mesothelioma have had this operation, together with chemotherapy or radiotherapy. However, it's a very big operation involves risks. 6 to 7 out of every 100 people who have undergone this particular operation die during the surgery or just after it.
Surgery for peritoneal mesothelioma
The surgery for peritoneal mesothelioma is called a peritonectomy. An operation called laparotomy is generally performed which involves the opening up of the abdominal cavity to remove a part or whole of the tumor.Doctors have been developing a technique known as cytoreductive surgery in recent years for peritoneal mesothelioma. In this method, 6 different peritonectomy procedures are used to remove as much of the cancer as possible. Then chemotherapy is given straight into the peritoneal cavity. According to some studies, this can work better if it is heated initially to a few degrees above body temperature, which is known as hyperthermic intraoperative intraperitoneal chemotherapy (HIIC). Promising results have been achieved using these techniques. 50% of the patients who had been treated in this way were alive even after 5 years. However, this is still only an experimental treatment.