Mesothelioma Surgery

Surgery is one of the most effective treatments for mesothelioma. Whether mesothelioma surgery is right for you will depend on a number of factors, including the location of the mesothelioma, the cell type of tumor, and the stage at which your mesothelioma cancer is diagnosed.

Even if your mesothelioma specialist doesn’t think that mesothelioma surgery is recommended for you, you may have one or more minor surgical procedures, to get more information about your mesothelioma tumor or to relieve the symptoms of the disease.

Can I Have Mesothelioma Surgery?

Surgery has the potential to add years to the life expectancy of some mesothelioma patients. Mesothelioma surgery is most effective in the early stages of the disease. After the cancer has spread to other organs or areas of the body, surgery usually can’t remove enough of the cancer to effectively stop or slow the progress of the disease.

In addition, some of the most effective mesothelioma surgery procedures are major operations. You and your medical team will need to decide if you are physically strong enough to survive and recover from these types of mesothelioma surgery. Your doctor may want you to take some tests of your heart and lung functions before deciding if surgery is your best mesothelioma treatment option.

Diagnostic Mesothelioma Surgery

If you have been exposed to asbestos and you have mesothelioma symptoms, your mesothelioma diagnosis will require multiple tests. Because mesothelioma has many of the same symptoms as other, more common, diseases, your doctor will need to rule out those diseases first.

Your doctor will have performed scans, x-rays, and tests before this point. You may have a thoracoscopy to get a better view of your mesothelioma tumor than you can get from a scan. The procedure requires a small cut between two ribs. Then a tube, equipped with a camera and light is inserted. This allows your doctor to see and take photos of your tumor from the inside. This procedure can give your medical team a better idea of the status of your mesothelioma cancer and help them determine the best mesothelioma surgery or other mesothelioma treatments.

A simple thoracoscopy is not enough for a mesothelioma diagnosis. The only way to definitively diagnose mesothelioma is through a biopsy. A biopsy extracts some cells from your mesothelioma tumor. This sample is examined under a microscope in a lab. The results of this lab test determine whether you have mesothelioma.

There are several different ways to take a biopsy via a thoracoscopy. Fine-needle aspiration is a simple procedure with a very small chance of complications and minimal discomfort. It involves inserting a long, thin needle into the tumor. Cells are sucked out into a syringe.

If your tumor is near the surface or large enough to see, your surgeon may perform the aspiration. If it’s harder to pinpoint the location, a specialist may use an x-ray or ultrasound to find the tumor during the procedure.

Before fine-needle aspiration, you will have to stay off certain medications (aspirin and anticoagulants, for example) for a few days. Afterward, you may have a bruise or feel sore at the spot where the needle went in.

The downside of fine-needle aspiration is that the small sample of tumor cells may not be enough to make a mesothelioma diagnosis. A core needle biopsy is similar to fine-needle aspiration, but it uses a larger needle and collects more tissue. This procedure is still minimally invasive.

To be sure and collect a large enough sample for a mesothelioma diagnosis, your doctor may want to take a larger biopsy by making an incision to expose the tumor and cutting out some or all of your mesothelioma cancer cells.

A biopsy that removes just a sample from your tumor is called an incisional biopsy or an open biopsy. You will receive a local anesthetic for this minor mesothelioma surgery.

During this procedure, your surgeon will make an incision between your ribs. This incision is called a thoracotomy.  He will remove a sample of the tumor and nearby tissue for examination in the lab. Afterward, you may have some pain or bleeding at the site of the incision. Though the cut will be small, you need to keep it clean to prevent infection. An incisional biopsy should be able to collect enough tissue for a mesothelioma diagnosis.

Your doctor may decide that it’s best to remove the whole visible tumor during the biopsy if it is small enough. This is called an excisional biopsy. In this procedure, your surgeon will remove the entire visible tumor and then send the tissue to the lab for analysis. Depending on the location and size of your tumor, you may need to have a general anesthetic during an excisional biopsy.

After the biopsy, your cells will undergo a cytologic examination. A pathologist will look at your tissue sample under a microscope to determine what kinds of cells are in your tumor and whether you have mesothelioma cancer. Your sample may also be viewed under an electron microscope, which allows a much closer view of cells. The electron microscope shows details about the cells that can help understand your malignant tumor better.

Debulking Mesothelioma Surgery

Debulking is a mesothelioma surgery procedure that removes as much of the cancerous tumor as your surgeon can safely cut out. This procedure is also called cytoreductive surgery. Cytoreduction means to lower the number of cancerous cells in the body.

Debulking is often used in combination with chemotherapy or radiation. Reducing the number of malignant cells in the body can make these mesothelioma treatments more effective.

This mesothelioma surgery may be particularly effective for patients with peritoneal mesothelioma. This mesothelioma type affects the lining around the abdomen. Cytoreductive surgery to remove the mass is often followed by an abdominal chemotherapy procedure called Hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery. During HIPEC, you will get heated chemotherapy drugs delivered directly into your abdomen through a tube.

Debulking mesothelioma surgery can take several hours, as your mesothelioma surgeon removes as much of the cancerous tissue as possible. You should plan to take it easy for at least a couple of weeks afterward, as you recover from this mesothelioma surgery.

Extrapleural Pneumonectomy Mesothelioma Surgery

 The first surgical procedure developed to treat mesothelioma was extrapleural pneumonectomy or EPP. This mesothelioma surgery is for the most common form of the disease: pleural mesothelioma. The pleura is the lining or mesothelium around the lungs. Most asbestos happens by inhaling the tiny, sharp asbestos fibers. When asbestos lodges in your lungs, it can cause pleural mesothelioma.

EPP is a major mesothelioma surgery. Your surgeon will remove the lining around your lung, the pericardium (the mesothelium or lining around your heart), part of your diaphragm, and one of your lungs. (Mesothelioma will attack only one of your lungs at first – if you catch it early enough, one lung remains healthy.)

Before the EPP procedure, your doctor will do a thorough health evaluation. This mesothelioma surgery is generally only recommended for early stage mesothelioma patients where the cancer is localized and has not spread or metastasized.

EPP mesothelioma surgery takes several hours, so you need to have the stamina to make it through a lengthy procedure. Being physically fit will make you a better candidate for EPP. After the surgery, you will have to rely on just one lung, which places an extra burden on your remaining lung and on your heart.

The EPP mesothelioma surgery is performed under a general anesthetic. The procedure starts with a long incision to expose your chest cavity. If the incision is on the front of your chest along your sternum, it is called a sternotomy. If your surgeon decides there will be better access through your side, the cut is called a thoracotomy. In some cases, the surgeon may need to remove one or two ribs to access the cancerous lung.

Once your chest is opened, your surgeon will look for cancerous growths and remove as much of the malignant tissue as possible. In place of the linings that protect your heart and lung, you might get a synthetic mesothelium made of a sturdy fabric such as Gore-Tex.

At the end of this mesothelioma surgery, your incision will be closed and a tube will be inserted to drain fluid from your chest during the recovery period. After you have healed sufficiently, your doctor will remove the tube.

After EPP, you will begin mesothelioma surgery recovery. Most patients spend at least two weeks recovering in the hospital. Your doctor will give you a device such as an incentive spirometer, which looks like a measuring cup you blow into. You will get breathing exercises to build up the strength in your remaining lung. You are likely to receive physical therapy as part of your recovery plan as well. Getting back your strength will be your primary job in the weeks following this mesothelioma surgery.

EPP is not without risks. As with any surgery, there is a risk that you won’t survive the procedure itself. Complications can include pneumonia, blood clots, or failure of your remaining lung. You may need to travel to have this mesothelioma surgery at a large and well-equipped medical center, if there isn’t one in your town.

For some mesothelioma patients, however, the benefits of EPP outweigh the risks. In the right case, it can be one of the most effective mesothelioma treatments. Some mesothelioma patients can live longer after this mesothelioma surgery, particularly when it’s followed up with chemotherapy and radiation. Although it is not a cure and mesothelioma usually returns, EPP can significantly slow down the progression of the disease. EPP can be an effective treatment to keep mesothelioma from metastasizing to other organs.

In addition, many mesothelioma patients feel much better once they recover from the EPP surgery. Even with only one lung, you are likely to have an easier time breathing once the tumor is removed.

Pleurectomy/Decortication Mesothelioma Surgery

A recently developed mesothelioma surgery that shows great promise for some patients with pleural mesothelioma is pleurectomy/decortication or P/D. P/D is sometimes called “lung saving or lung sparing surgery” because it leaves both lungs intact. It is a less invasive surgery than EPP and the recovery is easier. The procedure is still a major surgery that requires several hours under general anesthetic.

Like extrapleural pneumonectomy, P/D is recommended for early stage mesothelioma patients whose cancer has not spread to other parts of the body. Before this mesothelioma surgery, your doctor will examine you to make sure you are well enough to withstand this long surgical procedure. Although this mesothelioma surgery leaves both lungs intact and removes less of the surrounding tissues, the survival rates for P/D are comparable to more invasive EPP procedure.

P/D is one mesothelioma surgery that includes two separate procedures. To start with, your surgeon will make a long incision, usually starting in your back along your spine and continuing to the ribcage, to open your chest. The first procedure is the pleurectomy, to remove all or part of the pleura (the lining around your lungs) and the mesothelioma tumor itself. Depending on what your surgeon finds during surgery, he may also remove all or part of your diaphragm and pericardium during the pleurectomy phase of this mesothelioma surgery.

The second part of the P/D is decortication. Decortication means to surgically remove all or part of the outside of an organ. In this phase of the mesothelioma surgery, your surgeon will examine the surface of your lung and the other exposed surfaces inside your chest. He will painstakingly remove any potentially cancerous growths.

Blood loss is a concern during and after the decortication procedure. Your surgeon will take the time to make sure most of the bleeding has stopped before closing the incision. As with EPP, you will probably have a tube in your incision at first, to drain excess fluids.

After a P/D procedure, you can expect to spend about one week in the hospital and several weeks recovering at home. You will be given therapy to strengthen your lungs and get you back on your feet.

P/D is most effective when followed up with chemotherapy or radiation or both. Like EPP, this mesothelioma surgery slows mesothelioma growth and metastasis and increases comfort. Without the mesothelioma tumor in your chest, you will breathe easier.

Surgeries for Pericardial and Testicular Mesothelioma

Pericardial mesothelioma affects the lining around the heart. Testicular mesothelioma affects the lining around the testicles, which is called the tunica vaginalis. These are the two rarest mesothelioma types. Testicular mesothelioma is so uncommon that there has not been much scientific study of it. There are surgeries that can increase life expectancy for both of these rare mesothelioma types.

A pericardiectomy treats pericardial mesothelioma by removing the pericardium or the mesothelial lining around the heart. The goal of this surgery is to resect or cut out the tumor and cancerous cells, without doing damage to the vital heart muscle.

A procedure to drain fluid from the sac around the heart is called pericardiocentesis. Fluid buildup can return after this procedure, so patients with pericardial mesothelioma are sometimes given a percutaneous balloon pericardiotomy. In this procedure, a tube attached to a balloon is placed between the mesothelial layers around the heart. This allows even more fluid to be drained. Reducing fluid buildup will not cure mesothelioma, but it can greatly reduce uncomfortable symptoms.

For testicular mesothelioma, surgery to remove the affected testicle or testicles is the best treatment. If the cancer has spread from or to the abdomen, cytoreductive surgery may also be indicated.

The good news is that, with early detection and surgery, patients with testicular mesothelioma have the longest survival rates of any of the mesothelioma types.

Surgery to Reduce Mesothelioma Symptoms

In some cases, you may decide to have mesothelioma surgery to reduce symptoms such as pressure from a tumor or an uncomfortable accumulation of fluid in your mesothelium. These procedures are referred to as palliative mesothelioma surgery.

Palliative care is designed to improve your quality of life rather than cure the disease or slow its spread. For patients with late-stage mesothelioma cancer, palliative surgery can be a helpful tool.

If your doctor feels you are strong enough for surgery, the choice to undergo palliative mesothelioma surgery is completely up to you. Don’t be afraid to ask a lot of questions so you can weigh the risks and benefits of this form of palliative care for mesothelioma.