The side effects of mesothelioma surgery are infection, pain, organ damage, bleeding, blood clots, cardiovascular complications, and respiratory effects.[1] It is important to weigh the risks of surgery against the potential benefits before making decisions regarding your treatment options.
Common Mesothelioma Surgery Side Effects
Mesothelioma patients might undergo one of many different types of procedures. The potential side effects depend on the procedure and other factors unique to the patient.
Some of the most common mesothelioma surgery side effects are:
- Blood clots
- Excessive bleeding
- Infection, including pneumonia
- Pleural effusion
- Air leaking from the lung
- Arrhythmia
- Pain
- Damaged organs
About Mesothelioma Surgery
Surgery is one of three main types of treatment for mesothelioma. Most patients undergo multimodal treatment, meaning they receive more than one type, such as surgery with chemotherapy, radiation, or both.
The goals of surgery for mesothelioma can be curative, to slow the progression of the cancer, or to relieve symptoms and as palliative care.
What Kind of Surgery is Done for Mesothelioma?
There are several types of surgeries mesothelioma patients might undergo depending on the type and extent of the cancer and the patient’s goals.
For pleural mesothelioma, surgeries to treat and slow or stop the progression of the tumors include:
- Extrapleural pneumonectomy
- Pulmonary decortication
- Pleurectomy/decortication
Peritoneal mesothelioma patients might undergo one of these procedures to slow the progression of the disease:
- Cytoreduction with HIPEC
- Peritonectomy
- Omentectomy
Palliative procedures are used to manage symptoms and improve quality of life:
- Thoracentesis
- Paracentesis
- Pericardiocentesis
- Talc pleurodesis procedure
- Mechanical pleurodesis surgery
There are also diagnostic surgical procedures, including thoracoscopy, laparoscopy, and biopsies.
How Long and Involved Is Mesothelioma Surgery?
This depends on the procedure. A simple diagnostic biopsy might take minutes. The most extensive tumor-removing surgeries can take multiple hours.
In general, procedures designed to slow tumor growth or even achieve remission are much more involved and lengthy. They take hours for surgeons to complete and require weeks or more for recovery.
Can Mesothelioma Be Cured By Surgery?
Curative surgery for mesothelioma is extremely rare. Most patients have advanced disease that cannot be cured. For patients seeking remission, extensive, risky surgery is necessary. It is rare but possible for some patients with earlier-stage disease to achieve long-term remission with surgery and other treatments.
Is Surgery the Best Treatment for Mesothelioma?
The best treatment for mesothelioma depends on individual factors for each patient. There is no single answer to the best treatment plan.
For some patients, surgery is not even an option because the cancer has spread too extensively. For others, it is a good choice for slowing the progression of the disease.
What Are the Drawbacks of Treating Mesothelioma with Surgery?
There are always risks associated with surgery, but they vary widely by patient and surgery type. Patients can suffer from one or more potential complications and side effects during and after surgery.
Another drawback is that the procedure might not accomplish what the patient and doctor hoped. Side effects can compound the disappointment.
Bleeding and Blood Clots
Patients usually lose blood during surgery. Blood loss is mostly incidental and does not affect normal body function; however, excessive bleeding can occur when a surgeon accidentally cuts a blood vessel.
Severe bleeding can also occur if cuts are not fully closed during the procedure or new bleeding begins after surgery. If severe bleeding occurs after surgery, the surgeon may have to go back in to stop the bleeding properly. If the patient loses a significant amount of blood, a transfusion may be necessary.[2]
Another possible complication is the formation of a blood clot. This can develop in the lungs, called a pulmonary embolism, or in the legs, called a deep vein thrombosis (DVT).
Blood clots occur because patients are unable to move much after surgery. Inactivity can cause clots to form. Blood clots are dangerous because they can migrate to the lungs, heart, or brain. Blocked blood flow in these areas can cause a heart attack, stroke, or pulmonary embolism, all of which can be fatal.[3]
Doctors may prescribe blood thinners after surgery as a preventive measure. Compression stockings are also useful in preventing clot formation.[4]
Pain
Pain is also a common side effect of mesothelioma surgery. Although this side effect is not fatal, it can have a serious impact on quality of life.
Most commonly, pain originates at the incision site and may not recede for some time after surgery. Some pain may never go away completely.
Opioid medications are used to control pain after surgery, which can help the patient take deep breaths and ambulate. Opioids do have potential side effects and risks, such as drowsiness and constipation, and could be habit-forming when used for long periods.[5]
Infections
Surgery also comes with the risk of infection, which can be deadly if not properly treated. Infection may begin at the incision site with symptoms like swelling, pus, and drainage.
It is generally not problematic when these symptoms are mild; however, if they are severe or persistent, they can indicate a more serious infection that requires long-term antibiotics.
Deeper infections beyond the incision site can also be serious, difficult to treat, and potentially deadly. These may require additional surgery or invasive procedures to help remove the infection.[3]
Pneumonia is one of the most common infections associated with chest surgery. It is a serious complication that can be fatal if not addressed. To minimize the risk of developing pneumonia, patients must breathe deeply and begin to walk as soon as possible after a chest procedure.
Anesthesia Reactions
General anesthesia also causes side effects. These side effects commonly include:
- Nausea
- Vomiting
- Muscle aches
- Confusion
- Sore throat
- Shivering
- Chills
These side effects are not serious and usually subside as the anesthesia wears off.
Rare but serious side effects include delirium, cognitive problems, and malignant hyperthermia. The latter is a rare but potentially fatal reaction to anesthesia that causes a fever to develop rapidly along with muscle contractions.[6]
Heart Complications
Surgeries for pleural or pericardial mesothelioma take place close to the heart. Because of this location, cardiac complications are specific risks for these procedures.
One of the most common side effects is arrhythmia, which is an irregular heartbeat. Other possible side effects include heart attack and fluid buildup around the heart, resulting in compression of the heart.[7]
Respiratory Side Effects
Respiratory side effects are specific to surgeries used to treat pleural mesothelioma because these procedures involve removing organs and tissues from or around the lungs.
Pleural effusion, a buildup of fluid around the lungs, may occur after surgical treatments for pleural mesothelioma. Blood, pus, or lymphatic fluid may also accumulate in this space, causing breathing difficulties.
Respiratory failure is also a rare but serious side effect.[7]
Irritation in the tissues that remain after chest surgery can cause a dry, uncomfortable, and persistent cough. Often, the cough disappears after several weeks as the lung or lungs adjust and re-expand.
Damaged Organs
Organs near surgical sites may be accidentally damaged during these procedures. For example, the surgeon could accidentally puncture a lung during a procedure in the chest cavity, leading to a collapsed lung.
During surgery for peritoneal mesothelioma, there is a possibility that the bowels, bladder, stomach, or other organs in the abdominal cavity could be damaged.[3]
Fatigue
Even when surgery is successful and causes minimal complications, it is a draining experience. The more invasive and extensive the procedure, the more likely it is to cause fatigue.
Patients undergoing major surgeries must be in otherwise good health, have adequate nutrition and recovery time, and rest after the procedure.
Lower-Risk Mesothelioma Surgeries
The risk of side effects during mesothelioma surgery depends on the actual procedure. Some procedures come with a low risk of side effects or complications:
- Thoracentesis/pleurocentesis
- Paracentesis
- Pericardiocentesis
- Pleurodesis
These are surgeries to drain fluid from around the lungs, heart, or abdomen. To conduct these procedures, the surgeon only inserts a needle or thin tube to draw fluid. General anesthesia is not usually needed, and the risk of side effects is minimal.
Other procedures carry more of a risk because they are more invasive and require general anesthesia. These procedures include thoracoscopy and peritonectomy.
A thoracoscopy is a minimally invasive procedure that uses small incisions and tools to conduct surgery in the chest cavity. A peritonectomy is a procedure to remove the lining of the abdominal cavity.
High-Risk Surgeries
Some patients with mesothelioma will undergo more radical procedures to try to cure the disease or extend life expectancy. For example, a thoracotomy is a large incision that allows the surgeon to open up the chest cavity.
Surgeons use a thoracotomy to perform more extensive surgeries, like pleurectomy/decortication. During lung decortication, the surgeon removes cancerous tissue from the surface of the lung. The pleurectomy involves removing part or all of the diseased pleura, the membrane surrounding the lungs.
During a pulmonary decortication and pleurectomy, the surgeon might also need to remove lymph nodes, parts of the lung or chest wall, and part of the diaphragm. The surgery can be extensive.
Any procedure that opens the chest cavity and removes tissue has a high risk of complications and side effects. This often requires going to the intensive care unit (ICU) after surgery and may require staying in the hospital for several days.[8]
The Risks of Extrapleural Pneumonectomy
By far, the riskiest and most radical surgery associated with mesothelioma treatment is extrapleural pneumonectomy. This surgery gives some patients with early-stage mesothelioma a chance of remission while extending life expectancy and possibly curing the cancer.
Complications and Side Effects
This surgery is extremely complex and comes with many risks, including a significant risk of death. Other complications include cardiac problems, bleeding, infections, and fistulas.[9]
Working with Experts in Extrapleural Pneumonectomy
Some mesothelioma experts believe the surgery is too risky and that the benefits do not outweigh the risks. This complex surgery removes the pleura, diaphragm, and lymph nodes from the affected side of the chest cavity.
What makes the surgery so controversial and risky is that it removes an entire lung. Ensure your surgeon has enough experience with the procedure to evaluate you for this option and carry it out safely.
The Risk of Death
In addition to the risks and side effects associated with other mesothelioma surgeries, this radical surgery can lead to patient death as the most extreme side effect. Up to 15% of these surgeries result in death, a risk higher than with other types of surgery.[10]
Patients who survive may experience long-term breathing complications and severe activity limitations.[9] About one in three patients who have this surgery will experience some serious complication or side effect.
Managing and Treating Mesothelioma Surgery Side Effects
Because mesothelioma surgery can cause side effects and complications, patients often require additional treatments following procedures.
For example, if a patient develops an infection from surgery, they will likely need antibiotics to treat it. The pain usually requires medications to manage.
If you undergo mesothelioma surgery and experience uncomfortable side effects, talk to your surgeon. Together with the rest of your medical team, they can develop treatment plans to manage these additional symptoms and complications.
How Successful Is Surgery for Mesothelioma? Risks vs. Benefits
Patients and their doctors must weigh the potential risks against the benefits of any medical treatment. Mesothelioma treatment has high stakes, both in terms of the risks and the benefits.
Can Mesothelioma Be Cured with Surgery?
It’s essential for mesothelioma patients to understand that any treatment is unlikely to cure mesothelioma. A rare handful of patients achieve remission with surgery, but the risks are high.
Deciding whether or not to risk a radical procedure is up to the patient with input from their medical team. Some people might want to take on the risks of something like extrapleural pneumonectomy, while others would rather be more conservative with treatments.
How Long Does Mesothelioma Surgery and Recovery Take?
Even when there are no major side effects, recovery from surgery can be uncomfortable and lengthy. Some procedures, such as minor palliative surgeries, take an hour or less and require minimal recovery.
The more extensive surgeries take many hours and require long periods of hospitalization. Recovering from the removal of a lung, for instance, might require months in the hospital. With just one lung, the patient will never fully regain their strength or former activity level.
Surgery always comes with potential risks and side effects. The more invasive the surgery and the closer it is to organs, the greater the risks. For mesothelioma, some types of surgical procedures come with serious risks. Before undergoing any surgery, it is crucial to understand the potential risks and side effects and weigh the benefits before going through with it.
