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Cancer surgery, like all types of surgery, has benefits, risks, and potential side effects. General anesthesia poses significant risks. Also, extensive surgical procedures that require large incisions or that go deep within the body pose a greater risk for side effects. The location of the surgery can also increase the risk of side effects.
With mesothelioma surgery, the risks are relatively high. Most surgical treatments for mesothelioma are extensive, invasive, and conducted near important organs like the heart, lungs, or bowels. Potential side effects include infection, pain, organ damage, bleeding, blood clots, cardiovascular complications, and respiratory effects. It is important to weigh the risks of surgery against the potential benefits before making decisions regarding your treatment options.
Bleeding and Blood Clots
Patients usually lose blood during surgery. Usually, the amount of blood lost is incidental and does not affect normal body function. However, excessive bleeding can occur when a blood vessel is cut accidentally during surgery. Severe hemorrhage can also occur if cuts are not fully closed during the procedure. If severe bleeding occurs after surgery, the surgeon may have to go back in to properly stop the bleeding. If the patient loses a significant amount of blood, a transfusion may be necessary.
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 are a risk 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. When blood flow is blocked in these areas, it can cause a heart attack, stroke or pulmonary embolism, all of which can be fatal. Blood thinners may be given to some patients after surgery as a preventive measure.
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 take deep breaths and ambulate. Opioids do have potential side effects and risks such as drowsiness, constipation, and could be habit forming when used for long periods.
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. When these symptoms are mild, it is generally not problematic. However, if these symptoms are severe or persistent, it can indicate a more serious infection that require long term antibiotics. Deeper infections that go 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.
General anesthesia also causes side effects. These side effects commonly include nausea, vomiting, muscle aches, confusion, sore throat, shivering, and 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.
Surgeries for pleural or pericardial mesothelioma take place in close proximity to the heart. Because of this location, cardiac complications are specific risks for these procedures. One of the most common side effects is arrhythmia, or an irregular heartbeat. Other possible side effects include heart attack and fluid buildup around the heart resulting in compression of the heart.
Respiratory Side Effects
Respiratory side effects are specific to surgeries used to treat pleural mesothelioma. This is because these procedures involve removing organs and tissues from the lungs 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. Pneumonia is common since taking deep breaths, coughing, and early ambulation can be difficult after such a large operation. Respiratory failure is also a rare but serious side effect.
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 accidentally damaged.
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. These include 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 thoracosopy is a minimally invasive procedure that uses a small incision and small tools to conduct surgery in the chest cavity. A peritonectomy is a procedure to remove the lining of the abdominal cavity.
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. A pleurectomy/decortication surgery is then conducted to remove as much of the diseased tissue from the pleura, lungs, diaphragm, pericardium, and lymph nodes as possible. 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.
The Risks of Extrapleural Pneumonectomy
By far the riskiest and most radical surgery associated with mesothelioma treatment is the extrapleural pneumonectomy. This surgery gives some patients with early stage mesothelioma a chance of remission while extending life expectancy and possibly curing the cancer. However, this surgery is extremely complex and comes with many risks, including a significant risk of death. Some mesothelioma experts actually 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.
In addition to the risks and side effects associated with other mesothelioma surgeries, this radical surgery can lead to patient death. As much as seven percent of these surgeries result in death, a risk higher than with other types of surgery. Patients who survive, may experience long-term breathing complications and serious activity limitations. About one in three patients who have this surgery will experience some type of serious complication or side effect.
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 to weigh the benefits before deciding to go through with it.
Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP
Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.