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Surgery may be used to treat mesothelioma in certain people. Surgery is generally used along with other treatments, such as chemotherapy and radiation therapy. Surgery for mesothelioma is very specialized and is usually done by surgeons with experience in this type of cancer. It may only be available in select centres in Canada. Surgery is used to:
The type of surgery done depends mainly on the location of the tumour, the stage of the cancer, the subtype of mesothelioma and other factors, such as a person’s age and overall health, and the goal of surgery. Side effects of surgery depend on the type of surgical procedure.
Whether or not the tumour is operable (resectable) also depends on its location, the extent of the tumour and how far it has grown into nearby tissues. The subtype of tumour also determines if it is resectable.
Because surgery to treat mesothelioma is a major operation, the person needs to be in good overall health, not have other serious illnesses and be able to tolerate surgery. Chemotherapy and radiation therapy are often used along with surgery, so the person also needs to be fit enough to have these additional therapies. Tests are done to make sure the person is healthy enough to have the operation and to help plan surgery:
Surgery may not be an option for people with poor performance statusperformance statusThe measure of how well a person is able to perform ordinary tasks and carry out daily activities. or who are in poor health.
The role and extent of surgery for treating pleural mesothelioma is somewhat controversial because of the risks associated with surgery used to treat this cancer. The following procedures may be an option for people with pleural mesothelioma.
People with early stage or localized (stage I) pleural mesothelioma may be offered a pleurectomy and decortication (P/D). During a pleurectomy and decortication, both the parietal pleura and visceral pleura are removed along with the tumour. The lung is not removed. A thoracotomy is done, in which the surgeon makes large cut (incision) through the chest wall in the side of chest. This allows the surgeon access to the chest cavity and lung. Drainage tubes are inserted so that fluid will drain from the pleural cavity and surrounding areas. This allows the lung to expand properly and helps with recovery.
A pleurectomy and decortication may be done in people who are older because there is less loss of lung function and P/D has somewhat less severe complications than an extrapleural pneumonectomy.
For more advanced stages of pleural mesothelioma, a pleurectomy and decortication can also be done to help control fluid buildup in the chest, improve breathing and relieve symptoms, such as chest pain caused by mesothelioma. In this case, the procedure is done to relieve symptoms (palliation).
People with stage I or stage II, and some people with stage III, pleural mesothelioma may be offered an extrapleural pneumonectomy (EPP). It is only offered to people whose mesothelioma is considered operable (resectable). If a pleural mesothelioma has spread into the diaphragm, surgery is often not done.
Extrapleural pneumonectomy is a major operation that removes the pleura, the entire lung, a portion of the diaphragm and often the pericardium. To do an extrapleural pneumonectomy, the surgeon does a thoracotomy. A large cut (incision) is made through the chest wall in the side of the chest. A thoracotomy allows the surgeon the best access to the chest cavity and lung.
The surgeon will also remove lymph nodes in the chest so they can be examined under a microscope.
Once all of the necessary tissues have been removed, the diaphragm and pericardium are repaired (reconstructed) if needed. The surgeon reconstructs the diaphragm and pericardium using a mesh material that allows these structures to work much like they did before surgery.
Drainage tubes are inserted into the chest to drain fluid from the pleural cavity and surrounding areas. This allows the remaining lung to expand and helps with healing.
Extrapleural pneumonectomy is most often used for people with more extensive pleural mesothelioma.
A thoracentesis is a procedure in which a needle is inserted through the chest wall into the pleural space to drain a buildup of fluid (pleural effusion). The fluid often builds up again, so a thoracentesis needs to be repeated when this happens. Sometimes a chest tube or pleural catheter is inserted to drain fluid.
Sometimes a special pleural catheter (tube) with a safety valve is placed. This device allows the person to drain excess fluid from their chest themselves so that they can avoid trips to the hospital.
Pleurodesis is done to prevent fluid buildup in the pleural space and further pleural effusions. Excess pleural fluid is drained, and then drugs or chemicals, such as sterile talc, are put into the pleural space through a chest tube. Pleurodesis prevents further fluid buildup because it seals the parietal pleura and visceral pleura together so there is no longer a space between them.
Pleurodesis is the most commonly performed palliative procedure for pleural mesothelioma.
Surgery is not often possible for people with peritoneal mesothelioma. However, the following procedures may be an option for people with peritoneal mesothelioma who are candidates for surgery.
People with peritoneal mesothelioma may have a peritonectomy, in which the membrane that lines the abdomen (peritoneum) is removed. This surgery is done to remove all or as much of the tumour as possible. Other structures, such as part of the bowel, may also need to be removed. Many people have tumours throughout the abdomen, so it can be difficult to remove them all.
An omentectomy removes the omentum, which is the layer of fatty tissue that covers the contents of the abdomen. Cancers of the peritoneum often spread to the omentum, so the omentum may also be removed for peritoneal mesothelioma.
A paracentesis is a procedure in which a needle is inserted through the abdominal wall into the abdomen to drain a buildup of fluid (ascites or peritoneal effusion). Sometimes a tube or catheter is inserted to drain fluid. Fluid often builds up again, so a paracentesis needs to be repeated when this happens.