Surgery

Surgery is an option when mesothelioma is diagnosed early. It is the physical removal of the malignant tumor and is used

• to take a biopsy to confirm a diagnosis,
• to attempt a cure by cutting out all diseased areas, or
• to provide palliative therapy (by joining the two layers of the pleura together to prevent recurrence of a pleural effusion).

Only 20-30% of patients with malignant mesothelioma meet the medical criteria for surgery. Pleural surgery involves major operations requiring prolonged anesthesia. Therefore, if a person is being considered for surgery, they will require certain tests to determine their ability to withstand the actual surgical procedure and anesthesia, the recovery period, and the consequences of surgery (which may include the removal of a lung). These include assessments of heart and lung function, overall health and nutritional status.

Patients who have certain heart problems (such as a recent heart attack, irregular heart rhythms, or poor function), poor lung capacity, or in whom the cancer has widely spread throughout the body are not good candidates for this surgery. CT and MRI scans can aid in deciding which tumors are likely to be successfully removed by surgery. The surgical procedures for malignant mesothelioma are major operations and have a long recovery time afterwards. Patients usually have pain, breathlessness, weakness and fatigue for up to months after surgery.

Pleural surgeries remove the affected mesothelium, affected nearby tissues, and as necessary part or all of a lung. Several types of surgery are used to treat pleural mesothelioma:

• A pleurectomy/decortication removes part of the lining of the chest and some of the tissues around it. This procedure can reduce the size of the tumor.
• A pneumonectomy removes a lung, the lining that surrounds the lung, and some of the tissues around it.
• Thoracentesis as a diagnostic or a palliative treatment. Fluid in the pleural mesothelium is removed by inserting a syringe into the mesothelium and withdrawing fluid.
• An extrapleural pneumonectomy is a surgical option when the tumor is localized and diagnosed early. This is a major surgery that is performed only by surgeons at a large specialized medical facility and is part of an extensive plan of treatment. Recovery time for the entire treatment is about one year.

Pleural surgery is mainly used as a palliative procedure. Statistics show little increase in the survival rate with the use of this procedure. The exception is extrapleural pneumonectomy that can give a survival rate of 3 ½ years.

Peritoneal surgery removes the affected mesothelium and as necessary the adjacent abdominal organ. Peritoneal surgery is mainly used as a palliative procedure. Statistics show little increase in the survival rate with the use of this procedure.

Pericardial surgery removes the lining around the heart. This is a palliative treatment and is not expected to result in a cure.

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