Surgery for Mesothelioma
Surgery is not a suitable treatment option for all people with mesothelioma and is usually used as a palliative measure i.e. keeping the disease under control rather than aiming to cure the mesothelioma. Surgery can be used in conjunction with radiotherapy and chemotherapy.
A recent study of 40 mesothelioma patients (pub April 2011, Annals of Thoracic and Cardiovascular Surgery, pp. 130-136) indicated that the best patients for aggressive treatment, including radical surgery, are those who are in good overall physiological condition and have early-stage epithelial mesothelioma.
There is some controversy over whether radical mesothelioma surgery should be used because of the risk of complications (infection being the most common complication).
However, recent work suggests that new treatments such as postoperative intrathoracic chemotherapy and photodynamic therapy following surgery can improve the prognosis of a mesothelioma patient.
There are 3 different types of surgery that may be used . . .
Pleurectomy Surgery for Mesothelioma
This is an operation to remove part or all of the pleura (sheets of tissue that cover the lungs) on one side of the chest with the surgeon taking away as much of the mesothelioma as possible. This may be achieved by open surgery although key hole surgery can be used in some patients. A pleurectomy can help relieve symptoms such as breathlessness and pain caused by a build-up of fluid in the lung.
Extrapleural Pneumonectomy Surgery for Mesothelioma
This is a major operation to remove the lung on the affected side and the pleura, diaphragm and pericardium (covering of the heart).
Peritonectomy for Peritoneal Mesothelioma
Peritoneal mesothelioma is a rare disease and traditionally has been associated with a gloomy prognosis. A speedy diagnosis and subsequent referral to a specialist treatment centre is important.
Surgery is rarely possible for people with peritoneal mesothelioma but may be used to relieve painful symptoms. A peritonectomy removal of the peritoneum (lining of the abdomen) is the usual procedure used but more recently cytoreductive surgery has been used using chemotherapy agents introduced directly into the abdomen at the time of surgery.
In a trial between 1998 and 2007 at Basingstoke and North Hampshire Foundation Trust (Eur J Surg Oncol. 2009 Sep;35(9):980-5) 17 consecutive patients who underwent surgery for peritoneal mesothelioma were analysed for clinicopathological features, operative procedures, early outcomes and survival. The trial illustrated that cytoreductive surgery combined with intraperitoneal chemotherapy appeared to be the best course of treatment for some patients with peritoneal mesothelioma.