Mesothelioma Surgical Procedures

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Mesothelioma Survival RateWhile chemotherapy and radiation are the most common treatments for mesothelioma, a rare form of asbestos cancer, surgery is also frequently recommended. Due to the nature of the disease and the number of internal organs it can affect, surgery is often complicated to perform. In evaluating whether surgery is advisable, a physician will weigh factors such as the stage of the disease, a patient’s general health, age, gender and weight. A patient’s participation in a clinical trial may also impact decisions about which type of surgery to pursue.

There are two general approaches to surgery: palliative surgery, which helps to alleviate the pain caused by a tumor or by symptoms associated with the disease, such as fluid buildup in the chest wall or abdominal cavity; and curative surgery, to slow or stop the growth of the disease and to extend a patient’s life. These categories of surgery are listed below, with specific examples of each type described:

Palliative surgery is performed when a tumor has grown beyond the mesothelium (a membrane covering most of the body’s internal organs) and cannot be completely removed. It will also be done if a patient is too ill for more invasive surgery. The goal of palliative surgery is to relieve symptoms, such as shortness of breath, and to improve a patient’s quality of life. This type of surgery does not increase survival time, but can make the time that a person has more comfortable and peaceful.

For example, many patients experience shortness of breath because fluid in the pleura pushes against the lungs. To reduce this symptom of mesothelioma, a doctor can perform a thoracentsis to drain this fluid. In some cases, the doctor will also inject either talc or drugs which create scar tissue into the chest to prevent further fluid from entering the chest cavity. PleurodesisThis technique is called a pleurodesis and is effective for a time. However, if this procedure is performed frequently, it can actually increase the chance of fluid returning to the chest cavity. Another risk is that cancer cells can deposit and grow in the area where the needle was inserted. However, these risks do not typically outweigh the increased comfort that a pleurodesis provides.

A similar procedure, called a paracentesis, is performed to remove fluid from the abdomen. Typically, anywhere between five to 10 liters of abdominal fluid will be removed. In the case of the rarest form of mesothelioma, pericardial mesothelioma, a procedure called a fine needle aspiration is used to drain fluid from the pericardium, the sac around the heart.

An ultrasound is typically performed before a drainage procedure in order to determine the exact location where the needle should be inserted. While there is some discomfort associated with the insertion of the needle, these procedures are considered relatively low-risk and usually quickly improve the comfort of patients.

Curative surgery is performed only when doctors believe there is a chance of curing the disease, and when a patient is strong enough to survive the procedure. Specifically, it is performed when doctors feel that they can remove the entire tumor and when the tumor has not spread aggressively. A complication arises, however, because it is not always possible to determine whether the cancer has spread; the cancer’s microscopic growth sometimes cannot be detected during a routine examination. When it is most effective, surgery leads to a remission, or a period during which a patient is cancer free. Some of the more common types of surgery are describe here. Pleural Mesothelioma Information

A pneumonectomy may be performed when a patient has pleural mesothelioma. In this procedure, a doctor will remove a patient’s lung. In some case, part of the diaphragm will also be removed. During the procedure, it may be necessary for a surgeon to remove one or more ribs in order to reach the lung. An obvious complication is that, with only one lung remaining, a patient has reduced ability to breathe after the surgery.

A peritonectomy may be performed to treat peritoneal mesothelioma. This surgery, which involves removing the abdominal wall, often provides comfort and less frequently results in a longer survival rate. Often, a paracentesis is performed prior to this surgery to remove fluid from the abdomen. There is a high risk of infection after a peritonectomy.

One of the most radical and aggressive forms of surgery for mesothelioma is extrapleural pneumonectomy. This complicated surgery is only performed when the mesothelioma is localized, and by experienced surgeons in larger medical centers. The procedure involves removing the affected lung, the pericardium, the diaphragm and the pleural lining of the chest wall. The pericardium and diaphragm are rebuilt, using prosthetics, and placed back in the patient’s chest.

After this surgery is performed, chemotherapy and radiation are administered, in what is called a multi-modal treatment plan. Atrial fibrillation—an irregular heartbeat—is the most common complication during this surgery. Like many radical surgeries, this procedure is also high risk. There is an elevated risk of death occurring within 30 days of the surgery. In the years since this surgery was first developed, it has become both safer and more effective. When successful, this surgery may help to extend a patient’s life by several years and improve his/her quality of life. However, its effect on long-term survival is still being determined and research on this procedure is being conducted.

In rare cases, surgery may also play a diagnostic role, revealing that mesothelioma has spread to the tunica vaginalis, which covers the testis. This type of tumor is frequently discovered after a misdiagnosis of a hernia occurs, and as a procedure to correct this is performed. It is difficult to treat this tumor, and curative surgery is not typically recommended.

Depending on the type of surgery performed, the timeframe for resuming activities like eating, drinking and walking will vary. Frequently, a doctor will recommend that a patient work closely with a pulmonary therapist. Patients should also avoid smoking or exposure to smoke, and stay at a healthy weight.