Many mesothelioma patients of any disease location and stage have important surgical options that can either increase the chances of survival or improve quality of life. Mesothelioma surgical procedures are developed and performed by highly skilled oncological surgeons specializing in mesothelioma.
Mesothelioma Surgery Overview
If you’ve been diagnosed with mesothelioma, it’s critical to explore all your treatment options, including surgery. Many mesothelioma patients are good candidates for palliative surgeries and some can even undergo life-extending curative surgeries.
Here is what every mesothelioma patient needs to know about their surgery options:
- Mesothelioma surgery can remove the mesothelioma from any location either fully or partially
- When mesothelioma is removed fully, it’s called a curative surgery
- Stage 1 and stage 2 mesothelioma patients are usually good candidates for curative surgery
- Stage 3 and stage 4 mesothelioma patients are usually good candidates for palliative surgery
- Curative surgeries for pleural mesothelioma include the pleurectomy with decortication and the extrapleural pneumonectomy
- Curative surgery for peritoneal mesothelioma is cytoreduction surgery often used with HIPEC (heated chemotherapy)
- Aggressive surgery for pericardial mesothelioma is the pericardiectomy
- All patients should seek a second opinion from a mesothelioma specialist before undergoing surgical treatment of any kind
Mesothelioma Surgery Goals
When patients are diagnosed with mesothelioma, it’s vital to explore all treatment options. It’s also critical for patients to have a good understanding of the goals of each type of treatment so that patients can play an active role in their own health decisions.
Different treatments have different objectives. No two treatment plans are the same for mesothelioma patients. If your doctor has recommended surgery, then you need to know the intention behind the recommended procedure.
There is always a certain level of risk involved in undergoing surgery, and patients should understand the full picture before agreeing to one type of surgery over another.
With surgery for mesothelioma, doctors hope to accomplish any of the following treatment goals:
- Collect sample tissue to diagnose mesothelioma cell type (biopsy)
- Eliminate mesothelioma completely from the chest, abdomen or heart
- Remove as much of the visible tumors as possible
- Prevent recurrence—when the cancer comes back after treatment
- Improve quality of life by relieving pressure from the chest, abdomen or heart
Throughout the diagnosis and treatment process, there are different types of surgeries doctors perform to accomplish these goals. Depending on where you are in the diagnosis and treatment processes, you may undergo any of the following types of surgeries:
Curative surgeries are intended to remove all visible signs of mesothelioma, effectively sending the patient into remission. During remission, doctors can no longer detect any visible signs of mesothelioma. While surgery alone cannot accomplish this, it’s the basis of all curative approaches to treating mesothelioma.
Though it’s called a curative surgery, patients should know that doctors are careful never to use the word “cure”. There is always a risk of recurrence, so there cannot be a cure for mesothelioma at this time. When doctors perform curative surgery, it’s because the mesothelioma is resectable, meaning it’s fully removable.
Curative surgeries are usually appropriate for stage 1 and 2 mesothelioma patients, and some doctors are known for performing curative surgeries on stage 3 patients.
Palliative surgeries are common for most mesothelioma patients unless you’ve been diagnosed at a very advanced stage and you’re not healthy enough to undergo even limited surgery. Palliative surgeries relieve painful symptoms by draining fluid or removing diseased tissues and tumors. Some palliative surgeries are minimally invasive and involve a small hollow needle being inserted into the chest or abdomen.
Though palliative surgeries are commonly associated with end-stage treatment, they can also be helpful for stage 1 and 2 patients awaiting curative surgery.
To diagnose mesothelioma accurately, doctors must remove and collect tissue and/or fluid samples from the mesothelioma site inside the chest, abdomen or heart. All mesothelioma patients undergo surgery during their diagnosis. Usually, diagnostic surgeries can be done with minimally-invasive procedures involving a needle and a small camera.
Other times, to diagnose mesothelioma, doctors perform open surgeries where they cut open the chest or abdomen. Open diagnostic surgeries also allow surgeons to remove larger chunks of tumors and see the extent of the disease.
Surgeries by Mesothelioma Location
The 3 forms of mesothelioma—pleural, peritoneal and pericardial—are considered different diseases. As such, they each have their own standard treatments, including specially developed surgical procedures.
Before undergoing surgical treatment for your condition, here’s what you need to know about the surgical procedures for different mesothelioma locations:
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 2 curative surgery options, both typically involve open surgery. There are also some minimally-invasive palliative surgeries that do not require open surgery.
As the first curative 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.
Most early-stage mesothelioma patients survive 2 years or longer after the EPP surgery, and its technique is being refined all the time to improve these survival rates.
The other curative 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 mesothelioma.
In stage 2 and 3 patients who have metastasis outside the pleura and into the lung tissues or chest wall, surgeons will also remove some of this affected tissue to prevent recurrence. In a more radical procedure, surgeons also remove the pericardium and/or the diaphragm.
EPP vs P/D Surgeries
Patients should also be aware that there remains contentious debate in the mesothelioma treatment community over which of these 2 procedures offers better long-term benefits for the patient. Each procedure has its pros and cons and comes with its own level of risk.
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 recurrence.
Be sure to discuss both surgical options thoroughly with your team of specialists to determine which procedure is right for you.
Peritoneal mesothelioma patients have the best prognosis of all 3 disease locations. Thanks in large part to the highly technical cytoreductive surgery, many peritoneal mesothelioma patients are surviving well past their original life expectancy. Cytoreduction surgery can be performed on peritoneal mesothelioma patients of early or advanced stages, depending on the individual patient.
Cytoreduction with HIPEC has allowed the average patient to achieve a 5-year survival.
During cytoreductive surgery, the surgeon opens up the peritoneal cavity and removes the peritoneum (peritonectomy) along with any visible tumors within the abdomen. Depending on how advanced the mesothelioma is, surgeons may achieve complete cytoreduction—a curative procedure that removes all visible signs of mesothelioma. Otherwise, surgeons achieve incomplete cytoreduction—a debulking procedure that still has enormous palliative benefits for the patient.
In part 2 of this procedure, surgeons apply a heated chemotherapy (HIPEC) solution to the open abdomen, allowing chemotherapy drugs to bath the organs and kill off remaining mesothelioma cells left behind.
Pericardial mesothelioma is extremely rare and most cases aren’t diagnosed until the autopsy. Many patients who do receive a diagnosis may not be eligible for aggressive surgery because they are no longer in good enough health.
If patients do receive a 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 tumor masses surrounding it. With high risk for complications, only highly skilled cardiac oncological surgeons can conduct such a complex procedure.
Though there isn’t a lot of solid data to report, there are cases of patients undergoing pericardectomies and surviving for up to 2 years after—a massive improvement from the average 6-month life expectancy for pericardial mesothelioma patients.
Who Is Eligible for Mesothelioma Surgery?
Surgery for mesothelioma is a highly complex undertaking. With pleural and pericardial surgeries being so close to the lungs and heart, there are risks involved in operating near these vital organs. Even cytoreduction for peritoneal mesothelioma poses its own set of risks.
Because complications can arise during and after surgery, only certain patients are eligible for procedures. Doctors want to make sure their patients can withstand the stresses that surgery imposes on the body and that they can make solid recoveries.
Here are factors that determine eligibility for surgery:
- Disease stage
- Patient age
- Overall health level of the patient
- Whether the patient has other health conditions such as heart failure or emphysema
Provided you meet the right criteria, surgeons want to conduct aggressive surgeries on eligible patients, as surgery-based multimodal treatment gives patients the best shot at long-term survival.
Top Mesothelioma Surgeons
If your doctor has suggested surgery as a primary treatment option for mesothelioma, then be sure to consult a specialist before going through with the procedure. Unlike general oncologists, mesothelioma specialists are cardiothoracic or gastrointestinal oncological surgeons specializing in malignant mesothelioma.
Three of the top mesothelioma surgeons available to treat new patients include:
- Dr. Avi Lebenthal — Brigham & Women’s Hospital and Boston VA, Boston MA
- Dr. Paul Sugarbaker — Washington Cancer Institute, Washington DC
For more information on mesothelioma specialists and getting a consultation for a second opinion, contact the Mesothelioma Justice Network today.
Our Justice Support Team is available to answer your questions and help get you the treatment you deserve. Don’t delay in getting potentially life-extending mesothelioma surgery.