Mesothelioma Surgery

Surgical Procedures for Diagnosis

If it can be avoided, doctors prefer not to use surgery as a diagnostic tool. It is always better to use less invasive strategies, but getting an accurate diagnosis is crucial for treatment and a clear prognosis, so sometimes diagnostic surgical procedures are necessary. A biopsy is a simple surgical strategy, which is not usually very invasive, and which can be used to determine if a tumor is malignant, and if it is, what type of cancer it is.

A biopsy involves removing samples of fluid, tissue, or both from a tumor, the fluid-filled areas of the mesothelium, or from an area where tumors are suspected but not confirmed. The simplest biopsy is a fine needle aspiration. The procedure involves inserting a thin, hollow needle, through the skin and into the area from which the sample will be collected. It requires only local anesthetic and is quick.

More invasive diagnostic surgeries may be needed if it is impossible to access the tumor with a needle. A core or incisional biopsy involves making a surgical incision so that the surgeon can reach the tumor and remove a small sample of tissue. To diagnose pleural mesothelioma, a patient may need to undergo a thoracoscopy or thoracentesis.

A thoracentesis involves draining fluid from the pleura for testing. This procedure can also be used as palliative care too, as draining out the fluid makes breathing easier and less painful. A thoracoscopy is more invasive and requires an incision so that a probe can be inserted to sample the pleural tissue.

Surgery for Pleural Mesothelioma

Pleural mesothelioma, the cancer of the pleura around the lungs, is the most common type of mesothelioma. Most surgeries to treat it are palliative, not curative. The best chance of curing pleural mesothelioma, in patients who are eligible for it, is to perform an extrapleural pneumonectomy, or EPP. This aggressive surgical procedure involves the removal of the entire lung, along with the pleura, from the side in which the cancer is found. It is a complicated surgery and only certain patients are good candidates for it.

Less extensive and less risky is a pleurectomy, which involves the removal of all of the pleura from one lung. In a radical or extended pleurectomy, other tissues may be removed as well. A debulking surgery is used to remove as much cancerous tissues as possible, but typically does not involve removing all of the pleura.

Surgery for Other Types of Mesothelioma

Debulking is a common type of surgery for patients with peritoneal mesothelioma, the cancer that attacks the lining of the abdominal organs. As with pleural mesothelioma, this can be done to try to cure the cancer if it is in the early stages or as palliative care.

Some patients with this type of mesothelioma may also undergo an omentectomy, surgery to remove the omentum. This is a layer of fatty tissue that covers the abdominal organs. Peritoneal mesothelioma often spreads to this tissue, necessitating its removal.

For pericardial mesothelioma, the cancer of the tissue around the heart, surgery is not common. It is very tricky to try to remove cancer from the pericardium, simply because it is so close to the heart. It can be done, but it is rare. For both pericardial and peritoneal mesothelioma, removal of fluid is a more common procedure to help patients feel more comfortable.

Goals of Surgery

There are several different goals of using surgery as a treatment for any type of mesothelioma, and these vary depending on the patient: to diagnose, to cure, to treat, to manage symptoms, and to slow disease progression. The type of procedure used depends on the stage of the cancer, the location of the cancer, and the overall health and prognosis of the patient.

Radical and aggressive, curative surgeries are only reserved for patients with cancer that has not spread too far and for those who are generally healthy enough to withstand the physical trauma of such a procedure. For other patients, surgeries are used more often as palliative care.

Surgery for any reason is serious and includes risks that can result in complications, ranging from mild to severe. Patients may even die while undergoing surgery, so choosing this kind of treatment should be well informed. Any of these surgeries can result in excessive bleeding, blood clots, infections, and other, more specific complications, including heart problems. Choosing a surgical procedure for mesothelioma should be made together with an experienced medical team and the patient’s closest loved ones.