Surgical Options for Mesothelioma
Survival rates for patients who undergo mesothelioma surgery increase drastically. Most people who undergo mesothelioma surgery live beyond the first year following their diagnosis. Many have survived well beyond five years. Curative surgical procedures have even sent several patients into full remission. Today, these people are considered mesothelioma survivors.
Different surgery types can be used on pleural, peritoneal, and pericardial mesothelioma patients. The type of surgery used depends on the patient’s unique case and how far the mesothelioma has spread. While stage 1 and 2 patients with epithelioid cell type are typically the best candidates, surgical options are still available to patients regardless of diagnosis.
Surgery Treatment Goals
In the early stages of mesothelioma, surgery can be performed with the goal of removing as much of the mesothelioma as possible. This is called curative surgery, and it can potentially send the mesothelioma into remission.
In the final stages of mesothelioma, curative surgery is no longer an option because the cancer has spread too far. Instead, surgeons use surgery as palliative therapy to help relieve symptoms and reduce pain.
Who Can Undergo Surgery?
Curative surgery performed in the early stages of mesothelioma is only used for patients who are deemed good candidates. There are a few factors that determine whether a patient is a good candidate for surgery. Typically, patients with epithelioid cell type are better candidates than patients with sarcomatoid cell type. This is because epithelioid cell type does not spread as quickly as sarcomatoid cell type so it is easier to remove.
Being a good candidate for surgery also means that the mesothelioma must still be localized. Further, the patient must be in good overall health. Surgery always presents health risks, so patients must be healthy enough to recover properly.
Palliative surgery is performed on patients with mesothelioma that cannot be removed completely. It is also performed on those who are too ill to undergo intense surgical procedures.
Your health care team will discuss surgical options with you, including your eligibility for surgery. They will also be able to discuss with you the potential risks associated with surgery.
Ask your health care team about the goals of the surgery and what to expect. This will help you prepare for what is to come after the procedure.
Types of Surgery
There are different types of surgery used to treat mesothelioma depending on the disease location.
Surgery types for pleural and peritoneal mesothelioma include:
- Extrapleural pneumonectomy (pleural mesothelioma)
- Pleurectomy with decortication (pleural mesothelioma)
- Cytoreduction with HIPEC (peritoneal mesothelioma)
Different surgeons specialize in different areas of the body. A thoracic surgeon performs surgery on the chest and can treat pleural and pericardial mesothelioma. A gastrointestinal surgeon performs surgery on the abdomen and can treat peritoneal mesothelioma.
Patients with pericardial mesothelioma may also be good candidates for a pericardiectomy, a procedure that removes the lining of the heart and surrounding tumors. Pericardial mesothelioma is rare and aggressive, so a pericardiectomy can be considered too risky. Your doctor will determine whether you are a good candidate for a pericardiectomy.
Extrapleural pneumonectomy (EPP) was the first surgery type used on pleural mesothelioma patients that had a meaningful impact on patient survival rates. With EPP, the surgeon removes the affected lung, the lung lining (pleura), the pericardium (heart covering), and a portion of the diaphragm. Synthetic materials are then used to reconstruct and stabilize the chest cavity.
The goal of the EPP procedure is to remove all visible parts of the tumor. This is why it is only performed on patients with stages 1 or 2 mesothelioma. EPP is often supported by chemotherapy or radiation therapy to help kill the remaining cancer cells that the surgeon could not remove.
Pleurectomy With Decortication
Pleurectomy with decortication (P/D) involves removing the pleura from the affected lung and the chest wall. The pleura on the space between the lungs (mediastinum) and the pleura coating of the diaphragm are also sometimes removed. However, unlike with EPP, the lung itself remains.
P/D can be performed on stage 1 and 2 mesothelioma patients as a curative surgery. It can also be used as palliative surgery on some patients to “debulk.” In these cases, surgeons remove as much of the tumor as possible to reduce pain.
Cytoreduction With HIPEC
Cytoreduction with HIPEC is a surgical procedure used to treat peritoneal mesothelioma. It involves a combination of removing the peritoneum (lining of the abdomen) and delivering hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) directly into the tumor.
The peritonectomy (removing the peritoneum) removes as much of the tumor as possible. Doctors then use chemotherapy drugs to kill even more mesothelioma cells. The drugs are heated to a few degrees higher than body temperature, increasing their ability to kill the mesothelioma cells.
Mesothelioma Surgery Improves Life Expectancy
Surgical procedures have shown to be very effective in increasing life expectancy in mesothelioma patients. Without surgery, 42% of mesothelioma pleural mesothelioma patients do not survive their first year.
All types of surgeries greatly increase first-year survival rates. For example, 88% of patients who undergo EPP surgery survive past their first year. Research shows that many patients who undergo mesothelioma surgery survive several years after their initial prognosis.
Talk to your health care team about the right surgical procedures for you. Regardless of your mesothelioma stage, there are surgical options that can improve your quality of life.