Mesothelioma treatment with surgery involves removing the tumor and some of the healthy tissue surrounding it. There are several types of surgery for mesothelioma treatment; is surgery a good option for you? If so, which type is best for you? That depends on the stage and location of the cancer.
Another factor is the reason for undergoing surgery. Surgery for pleural mesothelioma, the most common type of mesothelioma, can be done to try to help relieve discomfort from mesothelioma symptoms. This is considered palliative. Or the goal of the surgery may be to try to remove as much of the cancer as possible. This is called curative intent. While surgery may not be able to completely cure mesothelioma, it may help prolong life.
The 3 Main Types of Mesothelioma Treatment Surgery
Extrapleural pneumonectomy (EPP): This is a major operation, but it can be the best way to try to remove as much of the cancer as possible. It’s an option for patients with mesothelioma that has not spread to the lymph nodes.
For this procedure, the affected lung and pleura lining the chest wall are removed. Surgeons may also remove the diaphragm, the pericardium (the sac around the heart), and adjacent lymph nodes. The diaphragm and the pericardium can be reconstructed with man-made materials.
Several tests must be done to make sure a mesothelioma patient is strong enough to withstand this intensive surgery. Major complications may occur in one third of patients who have this operation.
Pleurectomy/decortication (P/D): This mesothelioma treatment surgery is less extensive. In this procedure, the affected pleural lining of the chest wall is removed, along with the pleura coating the lung and diaphragm. The lung itself and the diaphragm remain although in a more extensive operation, considered to be radical or extended P/D, the diaphragm and/or pericardium also may be removed.
This surgery can be used to try to halt mesothelioma in its early stages. It is also performed as a palliative procedure. It may help improve breathing, limit the build-up of fluid and decrease pain.
Debulking (partial pleurectomy): The goal of this more limited surgery is to provide relief from mesothelioma symptoms. In general, less tissue is removed in this operation than in a P/D procedure.
Possible Side Effects of Mesothelioma Treatment with Surgery
Mesothelioma treatment with surgery is considered a major operation. Like all operations, mesothelioma treatment with surgery brings risks and side effects. These can vary based on the extent of the surgery and the health condition of the mesothelioma patient. Serious complications of EPP can include bleeding, blood clotting, infections, pneumonia, fluid buildup in the chest, and impaired lung function. These are less common with the other less extensive types of mesothelioma surgeries.
As with any surgery, there will be a recovery time during which your diet and activities will be restricted. You may need medication to help relieve post-operation pain. Untreated pain could slow down your mesothelioma treatment surgery healing process. You may want to downplay pain and other symptoms to not worry family and friends. But it is important to acknowledge any pain you may experience. Tell your healthcare team exactly how you feel.
Factors That Improve the Outcome of Mesothelioma Treatment Surgery
Before undergoing surgery for mesothelioma treatment, it is important to be informed about all possible outcomes and what factors may play a role in determining them.
Physicians who work with mesothelioma patients want to do their best to help them and to optimize their lives as much as possible. In a recent study, thoracic surgeons in England wanted to know more about the surgeries they were performing to increase mesothelioma survival. They studied the records of 252 mesothelioma patients who had undergone surgery for mesothelioma treatment. To be included in the study, a patient had to have survived a minimum of 90 days. The surgeons defined long-term mesothelioma survival as 24 months or more.
Publishing their results in the European Journal of Cardiothoracic Surgery, the surgeons reported several factors that made a difference. They came up with a list of four factors they say can be used to predict long-term survival in mesothelioma patients who undergo surgery for mesothelioma treatment:
- Being under age 60 at the time of the surgery
- Having the epithelioid cell variety of mesothelioma
- Having already had some chemotherapy
- No spread of cancer to the lymph nodes
You cannot change how old you are when you are diagnosed, or the type of mesothelioma you have, or whether it has spread into your lymph nodes. Of the four predictive factors identified in the study, the only one that can be an option is having chemotherapy treatment before surgery. Discuss with your doctor whether undergoing chemotherapy before surgery would be beneficial for you.
A cancer center’s level of experience in dealing with mesothelioma may also be an important factor in achieving good surgical outcomes, according to another study. The researchers reached this conclusion by analyzing a total of 16 large studies on mesothelioma surgery gathered from five international databases. Centers specializing in malignant pleural mesothelioma management had overall better results. If you need to travel to reach a cancer center that has a specialty in mesothelioma, there are programs that can help you and your family with transportation and hotel expenses.