Surgeries Involved In Treating Mesothelioma

While surgery alone is generally not viewed as very successful in the treatment of mesothelioma, it is often combined with other treatments, such as radiation and chemotherapy within a multi-pronged approach. Surgery may be required as early as the diagnostic stage, to address symptoms related to the disease, and then as potential curative procedures.

Some of the common surgeries that are involved with the treatment of mesothelioma include thoracoscopy, video-assisted thoracic surgery (VATS), mediastinoscopy, laproscopy, chest tube drainage and pleurodesis, thoracoscopy and pleurodesis, pleuroperitoneal shunt, pleurectomy, pleurectomy/decortication, extrapleural pneumonectomy, and cytoreductive surgery. These procedures are listed from diagnostic to potentially curative surgeries, and are discussed further in the following paragraphs.

Diagnostic Surgeries for Mesothelioma

A diagnostic surgery may be necessary to confirm and the presence of mesothelioma, and then to determine its stage of development.

Thoracoscopy enables the physician to evaluate the pleural cavity and conduct multiple biopsies. In up to 98% of the cases, a diagnosis can be obtained. This procedure can also determine the extent of the tumor and make a determination of surgical resectability.

Video Assisted Thoracic Surgery is an alternative to thoracoscopy. However, this is a more invasive surgery, and therefore there are more concerns with tumor seeding. The surgeon utilizes small incisions and then can view the pleural space with the assistance of a camera. The surgeon can also obtain tissue samples and determine the size and depth of the tumor.

Mediastinoscopy is sometimes used as an aid in staging extent of disease when enlarged nodes are seen using imaging techniques.

Laproscopy is used in mesothelioma patients in cases where imaging techniques suggest possible invasion of the tumor through the diaphragm. This information can be important in evaluating a patient for potential pleurectomy or extrapleural pneumonectomy.

Surgeries utilized to treat symptoms of mesothelioma (Palliative procedures)

Chest Tube Drainage and Pleurodesis is considered the most common of the palliative treatments, or surgeries used to treat symptoms of mesothelioma. Fluid build-up, or pleural effusion, is most often the first symptom which will prompt mesothelioma patients to seek medical attention. Once this effusion has occurred, it is many times persistent, returning rapidly after initial thoracentesis (draining of the fluid). In order to eliminate this problem, the pleural space must be closed. This is accomplished by use of a talc slurry or other sclerosing agent which produces an adhesion.

Thoracoscopy and Pleurodesis is done in conjunction with VATS using a powdered form of talc versus talc slurry. Both this and chest tube drainage and pleurodesis will be only effective if there is no tumor encasing the lung which restricts its expansion.

Pleuroperitoneal Shunt plays a limited role in palliation for several reasons. It involves placement of a catheter run under the skin from the pleural to the peritoneal cavity. Obstruction of the catheter and possible seeding of the tumor into the abdominal cavity may be concerns.

Pleurectomy, used as a palliative procedure, may be performed where more extensive surgery is not an option. In these cases, it is understood that all visible or gross tumor will not be removed. It is considered the most effective means of controlling fluid build-up in cases where the lung's expansion is restricted by disease.

Surgeries utilized as potentially curative treatments of mesothelioma

For Pleural Mesothelioma the following procedures may be performed:

Pleurectomy/Decortication is usually performed on patients with early stage disease, and attempts to remove all of the tumor. If it is found that all tumor cannot be removed without removing the lung, this may be done at the same time and is called pneumonectomy.

Extrapleural Pneumonectomy is considerably more radical than other surgical approaches, and should be carried out by surgeons with great expertise in evaluating patients and performing the procedure itself. Because in the past surgery alone has failed to effect a cure, or even to help prolong life for any extended period of time, it is currently being combined with traditional chemotherapy and/or radiation, or other new approaches such as gene therapy, immunotherapy or photodynamic therapy.

For Peritoneal Mesothelioma, Cytoreductive Surgery is aimed at removing all or nearly all of the gross or visible tumor in the peritoneal cavity. In order to treat any remaining cancer cells, Intra-Peritoneal Hyperthermic (heated) Chemotherapy (IPHC) is then delivered to the abdominal cavity. The type of chemotherapy drug used may vary according to the physician's preference.

Conclusions - Mesothelioma Surgery

Unfortunately, surgery is a likely course of action all the way from diagnosis to attempts to cure the patient of the disease. Because of this, the mesothelioma patient likely faces several surgeries, combined with other treatments such as a radiation and chemotherapy. This makes treatment of mesothelioma quite difficult for many patients. As a result, the medical community continues to be quite focused on developing new treatments for the disease, since it is likely that the number of cases will continue to rise globally.