Wedge Resection in Mesothelioma: Diagnosis and Treatment
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Wedge resection in mesothelioma diagnosis and treatment plays a vital role for many patients. It involves the surgical removal of a piece of lung tissue, either to remove a biopsy sample for diagnosis or to remove tumors as part of treatment.
Resectable Mesothelioma
Typical treatment for mesothelioma includes a combination of chemotherapy, surgery, and radiation therapy.[1] Surgery is often the best way to attempt to achieve remission or extend survival time, but not all patients are candidates for surgical procedures.
Mesothelioma is resectable when the treatment team determines that a surgical procedure is a valid option for slowing the spread of cancer or curing it. Whether or not pleural mesothelioma is resectable depends on several factors.
The most important factor is the stage. Most cases of stage I are resectable, many cases of stage II are, and some people in stage III may be considered for surgical procedures.
Stage IV is not generally resectable because the tumors are too widespread. Surgeries during this stage are largely palliative.[2]
If your medical team decides that your mesothelioma is potentially resectable, you can use their advice to determine if you would like to go ahead with surgery, and if so, with what type.
Mesothelioma surgeries are generally aggressive to match tumor growth. Surgeons will always try to remove as little tissue as possible to minimize complications and preserve function.
What Is a Wedge Resection?
Of the many surgical procedures to treat or manage pleural mesothelioma, wedge resection is among the more conservative. The surgery removes a wedge-shaped piece of lung tissue, usually containing both the tumor and some healthy tissue around it.[3]
Surgeons may also use wedge resection to treat lung cancer. They can usually do this with a minimally-invasive procedure. Just a few small incisions are used to perform the surgery rather than opening up the chest. This minimizes the risks of complications like infection and also speeds recovery.[4]
In addition to being used for cancer treatment, a wedge resection may be performed for diagnosis. If more tissue is needed for examination than a needle biopsy can provide, this surgery can remove enough cancerous tissue to study.
Wedge Resection for Pleural Mesothelioma
Pleural mesothelioma is challenging to treat and nearly impossible to cure because it forms multiple, small tumors. The growth pattern makes it challenging to remove all cancerous tissue surgically.
A wedge resection is not often used for pleural mesothelioma for this reason. It simply isn’t radical enough to remove a significant amount of the tumors.
A wedge resection may be useful for a biopsy as part of the diagnosis process. It may also be used as part of a more extensive surgical procedure.
For instance, a patient may undergo a pleurectomy/decortication surgery, which removes the pleura and additional tissue. The surgeon can use wedge resection to remove tumors that have infiltrated lung tissue.[5]
In earlier stages of mesothelioma, a wedge resection used along with pleurectomy and decortication may be curative. This strategy is primarily useful before the cancer has spread widely in the lungs. It can undoubtedly prolong life expectancy by slowing the spread of the tumors.
The Risks of a Wedge Resection
When performing surgical procedures to slow the spread of cancer or cure it, surgeons must always balance the benefits against the risks. The more extensive a surgery, the greater the risk of complications and serious complications.
A wedge resection is relatively conservative compared to the more extensive surgeries often done to manage pleural mesothelioma. Still, there are some potential risks:
- Complications related to anesthesia
- Infections
- Bleeding at the incision site
- Internal bleeding in the chest cavity
- Air leaks that may lead to a collapsed lung
- A hole between the lung and pleural tissue
If VATS, or video-assisted thoracoscopic surgery, is a possibility for your treatment, the risks are less but still significant.
Recovering from Surgery
Recovery from a wedge resection takes less time than from a more extensive procedure, especially if you underwent a VATS procedure. However, when used for pleural mesothelioma, a wedge resection is often part of a more radical surgery. You may need to be in the hospital for up to ten days or two weeks to recover.
Once home, you will need to monitor your symptoms and the incision sites and contact your medical team if you have any concerns. Look for swelling, redness, or bleeding at the incisions, a fever, difficulty breathing, chest pain, coughing, or shortness of breath.
A wedge resection can be a useful tool in managing pleural mesothelioma. Unless you are in the very early stages, it is unlikely this procedure will be curative, but it may help you live longer and have fewer symptoms. Talk to your doctor about surgical options to make the best decisions for your treatment.
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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.