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For the patient suffering from Mesothelioma, surgery is the primary curative treatment option. The surgery is done to remove mesothelioma from the lining of the lung, abdomen, or heart, but it is not suitable for everyone suffering from this disease. Surgery only aims to keep the cancer under control and improve long-term survival. Life extending surgeries are performed for the patients with stage one or stage two mesothelioma. If the patient has been diagnosed at later stage mesothelioma, doctors can improve patient’s quality of life with palliative surgery for relieving pain caused by symptoms of the disease.
Different surgical procedures are followed according to the types of mesothelioma.
Extrapleural Pneumonectomy (EPP):A pneumonectomy may be performed to remove the entire lung, the lining around it, nearby lymph nodes and parts of the pericardium and diaphragm. The parts removed are then replaced with Gore-Tex, a breathable fabric membrane. EPP is most effective for patients with stage 1 or stage 2 mesothelioma. EPP is not generally suggested for later stage patients due to the risk associating with the surgery. Removal of an entire lung may result in permanent reduction of the patient’s stamina.
P/D is a lung-saving surgery for pleural mesothelioma patients. During this procedure, the lining of the affected lung (pleura) is removed along with any tumors on the surface of the lung. Doctors often combine the P/D with intraoperative radiation to kill remaining mesothelioma cells.
Both EPP and P/D begins with a thoracotomy, an incision that opens the chest. Instead of removing an entire lung as they do in EPP, a pleurectomy is performed which is the removal of the inner and outer lining of the lung affected by tumor growth. After pleurectomy, decortication, scraping the surface of the lung, is performed to remove all visible tumors.
Cytoreduction/Debulking:The abdomen contains a lot of organs. There are many where mesothelioma can spread to various abdominal organs easily. Surgeons use this procedure to remove as much tumor growth from the lining of the abdominal cavity as possible. Depending on how far the cancer has spread, surgeon may also remove parts of the gall bladder, pancreas, and stomach. It is intensive surgery which often includes a HIPEC wash.
Hyperthermic intraoperative Chemotherapy (HIPEC):
Majority of cytoreduction patients often receive Hyperthermic intraoperative Chemotherapy (HIPEC) during the surgery. HIPEC is a heated chemotherapy bath in the abdominal cavity. While cytoreduction reduces the tumor mass, the heated drugs kills microscopic cancer left behind after the surgery.
Peritonectomy mesothelioma is first developed in the lining of the abdomen. This surgery removes the lining in an attempt to remove all of the cancerous tissue from the body. This treatment combined with HIPEC has one of the highest success rates out of all mesothelioma surgeries.
Palliative surgeries are used to relieve pain caused by tumor growth. They are used in all stages of mesothelioma. They are used to relieve pain by draining or preventing the build-up of fluid in the mesothelial cavities. Uncomfortable pressure, breathing difficulties, and pain are the symptoms caused by fluid build-up in the mesothelial lining surgical options available for these patients.
This procedure is used to seal the pleural cavity, the space between the inner and outer lining of the lung and limits fluid build-ups. The most common symptoms of pleural mesothelioma is pleural effusion, a fluid build-up in the pleural surrounding lungs. Therefore, sealing this cavity prevents pressure caused by pleural effusions and prevents them from recurring.
It is the procedure used to remove excess fluid in the lining of the lung affected by tumor growth. A needle is used to drain fluid in this procedure, but it does not close the pleural space.
This process involves removal of excess fluid in the lining of the abdomen. Like thoracentesis, a needle is used to remove the excess fluid. The fluid build up is known as ascites.
This procedure is used to drain fluid build-up from the sac lining the heart (pericardium) with needle.
An IPC is a pain relieving treatment for patients with recurring pleural effusions. A small incision in the chest is made and a catheter is inserted into the lung’s lining and excess fluid is drained in the comfort of the patient’s home.
Which of these surgery options is the right choice?
Most patients suffering from Mesothelioma has at least one surgery option available, whether it’s curative, palliative, or both. The location of the disease, how far the disease has spread, and overall health of patient are the factors determining which surgery option is the best. If mesothelioma is at later stage, one of the palliative surgeries is probably the best choice. And patient who has been diagnosed with early stage mesothelioma, they may be eligible for curative surgery that can extend patient’s life expectancy.
Whether it is palliative or curative surgery, patient should be well aware of the surgical process. They should always seek a second opinion before any decision is made. Every opinion matters before making any sorts of decisions.