Mesothelioma Surgery Options
The three mesothelioma locations — pleural, peritoneal and pericardial — are all considered different diseases.
As such, they each have their own standard treatments, including specially developed surgical procedures. Your doctor will perform specific surgeries depending on what type of mesothelioma you have.
Here’s what you need to know about the surgical options for each mesothelioma location:
Pleural Mesothelioma Surgeries
Pleural mesothelioma surgeries involve making a small or large incision in the chest cavity, depending on the technique being used. For pleural mesothelioma, there are two surgery options, both typically involve open surgery.
Doctors will perform either an extrapleural pneumonectomy (EPP) or pleurectomy with decortication (P/D) to treat pleural mesothelioma.
Extrapleural Pneumonectomy (EPP)
As the first surgical procedure developed for pleural mesothelioma, the extrapleural pneumonectomy (EPP) is a commonly performed procedure for stage 1 and 2 pleural mesothelioma patients. It can also be done on stage 3 and 4 patients in certain cases
During the EPP, the surgeon removes the affected lung, the pleura (lung lining), the pericardium (heart lining), part of the diaphragm, and nearby lymph nodes.
It’s an extensive procedure only conducted by highly skilled thoracic oncological surgeons. The EPP procedure, in conjunction with chemotherapy and/or radiation, can extend patient lives by several months.
Pleurectomy With Decortication (P/D)
The other surgery option developed for pleural mesothelioma is the pleurectomy with decortication (P/D).
Called a lung-saving surgery, the P/D allows the patient to keep their lung, but surgeons remove the diseased pleura (pleurectomy) and any surrounding tumors (decortication).
P/D surgery is usually only performed on stage 1 and 2 patients who have fully resectable (removable) mesothelioma.
In stage 2 and 3 patients who have metastasis (mesothelioma that’s spread) outside the pleura and into the lung tissues or chest wall, surgeons will also remove some of this affected tissue to prevent a recurrence.
In a more radical procedure, surgeons also remove the pericardium and/or the diaphragm.
Which Surgery Is Right for Me?
You can make an informed choice between extrapleural pneumonectomy and pleurectomy with decortication surgery by working with a pleural mesothelioma specialist. Only an experienced mesothelioma doctor can help you choose the right course for you.
EPP vs P/D
Patients should be aware that there is a contentious debate in the mesothelioma treatment community over which of these two procedures offers better long-term benefits for the patient.
Both of these procedures have benefits and risks, and it is important for patients to discuss the pros and cons with their medical team to understand which option is best for them
While some patients can still have a high-functioning and high-quality life with only one lung, some experts feel that removing the lung is unnecessary. Proponents of the EPP say it’s the best way to prevent a recurrence.
Be sure to discuss both surgical options thoroughly with your team of specialists to determine which procedure is right for you.
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Peritoneal Mesothelioma Surgery
Peritoneal mesothelioma patients have the best prognosis of all three disease locations, thanks in part to cytoreductive surgery. This highly technical procedure has enabled many peritoneal mesothelioma patients to survive well past their original life expectancy.
Cytoreduction With HIPEC
During cytoreductive surgery, the surgeon opens up the peritoneal cavity and removes the peritoneum (peritonectomy) along with any visible tumors within the abdomen.
Heated chemotherapy (HIPEC) drugs are then applied to the open abdomen to kill any unseen cancer cells.
Cytoreduction surgery can be performed on peritoneal mesothelioma patients of early or advanced stages, depending on the individual patient.
Pericardial Mesothelioma Surgery
Pericardial mesothelioma is extremely rare and most cases aren’t diagnosed until the autopsy.
If patients receive an early diagnosis and they are good candidates for surgery, then surgeons will perform a pericardectomy.
During a pericardectomy, the surgeon removes the diseased pericardium and any tumors surrounding it. Due to its high risk for complications, only highly skilled cardiac oncological surgeons can conduct such a complex procedure.