Surgical Treatments for Pleural Mesothelioma
There are a variety of surgical procedures and treatments for pleural mesothelioma. Below is an overview of a few of the most frequent ones used in patients.
This procedure is used to minimize pleural effusion, the build-up of fluid in the pleural space surrounding the lungs. The fluid can make it difficult for a mesothelioma patient to breath. The procedure involves the surgical puncture and drainage of the thoracic cavity and is usually performed in an outpatient setting with a long, thin needle that is inserted into the pleural space.
Pleurodesis is a surgical procedure that uses chemicals, talc or drugs to scar the space between the layers of the pleura. First, fluid is drained from the space using a catheter or chest tube. Next, the chemical, talc or drug is put into the space. The scarring stops the build-up of fluid in the pleural cavity. This is sometimes referred to as a “talc procedure.”
Pleurectomy / Decortication
Pleurectomy / Decortication refers to a lung-sparring surgery to remove the mesothelioma cancer by removing part of the covering of the lungs, lining of the chest, and part of the outside surface of the lungs. The goals of the operation are to re-expand the lung and remove the disease process affecting the pleural space so that pulmonary (lung) function and symptoms will improve.
A pneumonectomy is a surgery that involves the removal of the lung that has been affected by mesothelioma. It has become the standard surgery for operable locally advanced lung cancer.
An Extrapleural Pneumonectomy or EPP is the most invasive surgery for mesothelioma and involves the removal of the diseased lung, part of the pericardium, (the membrane that covers the heart), part of the diaphragm (the muscle that lies between the abdomen and the lungs), and part of the parietal pleura (this is the membrane that lines the chest). An EPP is typically performed only on patients with early stage localized disease that has not metastasized to the lymph nodes or to other tissues and organs. Sometimes heated chemotherapy is introduced during an EPP in order to bathe affected tissues. Although an EPP can impact life expectancy for some patients, there can be significant risks to this procedure. These risks may include: internal bleeding, respiratory failure, infection and blood clots. In addition, some patients undergoing extrapleural pneumonectomy die during or immediately following the procedure. That percentage is, however, lower at medical centers that specialize in this surgery.
Perhaps the greatest area of dispute now is whether an extrapleural pneumonectomy (EPP) or pleurectomy / decortication is the most appropriate curative operation for mesothelioma patients who are candidates for both procedures. There are leading mesothelioma surgeons who take contrary point of view. For example, Dr. Robert Cameron at UCLA has endorsed a lung sparring approach while Dr. David Sugarbaker of Brigham and Women’s Hospital has advocated for EPP. The 2011 MARS study (Mesothelioma and Radical Surgery randomized feasibility study) concluded that, “radical surgery in the form of EPP within trimodal therapy offers no benefit and possibly harms patients.”
Surgical Treatments for Peritoneal Mesothelioma
Similar to pleurocentesis, paracentesis is a procedure in which fluid from the abdomen is removed through a needle. It is performed on peritoneal mesothelioma patients to remove pressure from the fluid.
Peritonectomy / Cytoreductive Surgery
Peritonectomy is the most common surgical procedure for peritoneal mesothelioma and involves the removal or stripping of the affected peritoneum (cancerous part of the lining of the abdominal cavity) from the underlying tissue. Peritonectomy is usually combined with cytoreductive surgery where the goal is to also remove as much of the cancerous growth as possible from multiple sites in the abdomen. The greater omentum is nearly always involved and has to be removed.
Doctors often perform cytoreductive surgery in combination with other mesothelioma treatments such a chemotherapy. For example, in a HIPEC procedure (heated intraperitoneal chemotherapy), surgeons introduce heated chemotherapy directly into the surgical cavity. In the peer reviewed medical literature, HIPEC procedures used in peritoneal mesothelioma management report superior survival statistics when compared to other surgeries.