Mesothelioma Surgery

Doctors use surgery for three purposes with patients that may have mesothelioma.

Diagnostic surgery is conducted for the purpose of determining the patient's affliction. These are minor operations, usually conducted with a local anesthetic.

Curative surgery is performed with the hope that it may halt the spread of mesothelioma, force it into remission and even affect a cure.

Palliative surgery is similar to curative in that it is conducted to remove cancerous tissue.  It is conducted on patients in whom the mesothelioma cancer has advanced beyond the point that it is considered curable; the purpose of the surgery is to relieve difficult symptoms.

Diagnostic Procedures

Biopsies play an important role in the diagnosis of malignant mesothelioma.  Although the purpose of these procedures is diagnostic, sometimes they will be followed by radiotherapy in order to avoid "seeding" malignant cells along the surgery's invasive route.

Thoracentesis is a pleural needle biopsy that extracts fluid from the pleural area through the use of a needle.  X-rays are often used to determine the best location for needle insertion.

Cytology is the general term for diagnostic cell study.  A small tissue biopsy may also be performed using a needle. Extraction of larger pieces of tissue may involve an incision in the chest so that the surgeon can insert an instrument between two ribs in order to excise the sample.

Thoracoscopy is a procedure that utilizes a tiny surgical camera called an endoscope to visually examine the pleura and other areas of the chest cavity.  It is also an opportunity to collect a tissue sample.  The procedure involves a chest incision for the endoscope and additional small incisions for surgical tools.  If there is substantial fluid in the pleural area a chest tube may be inserted for drainage purposes.

Curative Mesothelioma Surgery

Curative surgery for any cancer generally involves removing the tumor or cancerous growth - in other words, excising the diseased tissue from the body.  Usually that is not entirely possible with mesothelioma, as cancerous cells can be spread throughout the area that has been impacted.  For that reason, mesothelioma surgery is usually combined with follow-up treatment utilizing chemotherapy or radiation therapy or both.

Thoracotomy is the umbrella term for lung surgery performed when there is a tumor present.  There are a couple of lesser procedures that are available to patients with an early diagnosis of mesothelioma - a rare occurrence, since the disease does not manifest itself usually until the malignant stage is well underway.

A partial, or wedge resection involves removal of a small portion of the pleura or the lung where cancerous cells have been identified as present.  A lobectomy removes one of the lung's five lobes.

A pleurectomy procedure removes an entire lung.  This is major surgery that may not be a reasonable choice unless the patient is otherwise in good health.

An even more radical step is the extrapleural pneumonectomy, a procedure that removes the lung along with a portion of the parietal pleura, that portion of the pleural membrane that lines the chest wall.  Along with these resections, a portion of the diaphragm and the pericardium, that portion of the membrane covering the heart may be removed as well.  This surgery is designed to stop cancerous growth from invading the abdominal cavity and heart area, as well as excise cancerous material from the chest cavity.

Peritoneal mesothelioma can be treated with curative surgery that attempts to remove tumors and cancerous tissue from the membrane lining the abdominal wall.  This surgery is also usually followed with chemotherapy and/or radiation therapy.

Palliative Mesothelioma Surgery

Thoracentesis may be used as a palliative measure as well as a diagnostic tool.  As a palliative measure, the procedure is used to extract as much fluid as possible from the pleural area around the lungs, thus relieving painful breathing and shortness of breath symptoms.

The next step beyond thoracentesis is pleurodesis, a procedure that closes off the space between the inner and outer pleural membranes surrounding the lungs.  This process eliminates the possibility of continued pleural effusion, or accumulation of fluid around the lungs.  Pleurodesis involves filling the space between the two membranes with talc, which creates filler that bonds the two membranes together.

The most radical approach to pleural effusion is the pleurectomy, during which the pleura itself is removed both in order to prevent further accumulation of fluid and to remove tumors that have grown on the membrane.