Mesothelioma Surgery Methods
When asbestos-cancer patients are presented with treatment options, surgery may be one of the first treatments recommended. In some cases, the surgery may be necessary to remove tumors. Other times, the surgery is palliative in nature, allowing patients to live more comfortably.
While there is no known cure for asbestos cancer, surgery can allow some patients to live with it as a chronic disease. The key is to diagnose the disease in the early stage. There are several different types of surgery that can be performed.
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Most major surgical procedures happen in a similar manner:
- The day before the surgery - The patient is admitted to the hospital one day before the procedure. This gives the medical staff to perform necessary tests and start important IVs.
- The day of the surgery - The patient is taken to the operating room, while family and friends gather in the waiting room. Once the procedure is over, the patient is taken to the post anesthesia care unit (PACU), also called the recovery room. The patient will have a breathing tube, numerous IV lines for fluids, pain medications and nutrition. Sometimes, the patient’s hands are restrained to prevent accidentally pulling out lines. The patient is moved to the surgical intensive care (SICU).
- The days following surgery - The stay in the SICU could last up to a week for some patients. During this time, each nurse has only one or two patients. That’s because post-surgical patients need individualized attention. The next stop will be the postsurgical floor of the hospital. Drainage tubes and some IVs will be removed.
- Going home - Every patient progresses at a different rate so it’s impossible to predict how long each hospital stay will be. Often, patients are released with a set of orders for home care.
Curative Surgery for Mesothelioma Cancer
For patients in the early stages, there are several surgeries that are used on the pleural and peritoneal areas. These surgeries are used as part of the multimodal, or the three-tiered, method that include surgery, chemotherapy and radiation.
- Extrapleural Pneumonectomy (EPP) - Pioneered by the famed Dr. David Sugarbaker, this surgery is risky. It involves removing the damaged lung, part of the pericardium, nearby lymph nodes, the diaphragm and the tissue casing around the lungs. The best candidates for this procedure are younger and have few health problems.
- Pneumonectomy - This is similar to the extrapleural pneumonectomy but slightly less severe. While the diseased lung is removed, other organs and tissue are not. This procedure is also intended for healthier patients with no other medical problems. It is mostly recommended for those in the earlier stages of asbestos cancer.
- Pleurectomy/Decortication (P/D) - In this procedure, doctors remove much of the pleura, which is the lining around the lungs. The procedure is followed by chemotherapy, radiation or photodynamic therapy. This is a less invasive surgery than the extrapleural pneumonectomy and the pneumonectomy. It is important to note that there is a debate among mesothelioma doctors about which surgery is more effective for early stage patients. Some say the extrapleural pneumonectomy and pneumonectomy are too invasive and can cause a difficult recovery period. Others say the pleurectomy involves a more detailed surgery and is a complicated procedure.
Palliative Surgery for Mesothelioma Cancer
For patients who are facing more aggressive asbestos cancer, palliative surgery can be a way to live a longer, more comfortable life. The goals of palliative surgeries are not lifesaving.
- Debulking - When the tumors become large, they can cause pain and pressure on internal organs. A debulking surgery is aimed at trimming back the tumors and relieving pain. This is also called cytoreduction and is often done in conjunction with hyperthermic interaperitoneal chemotherapy (HIPEC) to dramatically reduce tumors.
- Pleurocentesis or Paracentesis - Both of these surgical procedures will prevent and removed fluid buildup in the abdomen and chest.
- Thoracentesis - This involves inserting a tube through the chest wall so fluids can drain. Doctors may also put talc in the chest cavity to calm inflammation and stop fluid accumulation. It is aimed at reducing the pain of a pleura effusion. A thorancentesis is also used as a diagnostic tool.
- Pleurodesis - Also used to prevent pleural effusions, this procedure is aimed at removing the pleural space. In this procedure, physicians put an irritant in the space between the pleura layers. This creates an inflammation that forces the layers to stick together and prevents fluid accumulation.
In some cases, doctors may need to perform a diagnostic surgery to determine the spread of the disease. This procedure may be as minor as an outpatient biopsy where a tissue sample is removed through a fine needle or an inpatient procedure where whole tumors are removed for further study.
No matter what the procedure, research shows that one of the keys to a successful outcome is having a doctor specially trained in mesothelioma on your case. Nationwide, there are several mesothelioma specialists who can help you.
Encyclopedia of Surgery. “Pneumonectomy.” Retrieved from http://www.surgeryencyclopedia.com/Pa-St/Pneumonectomy.html
The University of Texas MD Anderson Cancer Center. Mesothelioma. Retrieved from http://www.mdanderson.org/