Surgery

Two types of surgery are often referred to: potentially curative and palliative. 

Potentially Curative: Potentially curative surgery is surgery performed with ‘curative intent’ – that is, the intent to remove all of the diseased cells from the affected areas while acknowledging that complete elimination of the disease is rare. Surgery for a curative intent is a serious undertaking, and should only be performed by a surgeon with significant experience and expertise in mesothelioma. There are many criteria that must be met for a surgeon to consider offering a curative surgery to a patient. These factors include the size of tumour, anatomical location of the tumour, if the tumour is enveloping some vital structures, the number and locations of lymph nodes that the tumor has spread to, the biology of the tumour as well as if the patient is healthy enough to undergo such an operation and recover from it. Curative treatment for mesothelioma is not possible in many cases, however a patient has the right to be treated by a team that has sufficient expertise in mesothelioma, since they are the only experts who are able to provide a cure. 

 Types of potentially curative surgeries proposed by your doctor might include: 

  • Extrapleural Pneumonectomy – the removal of the diseased lung as well as the areas surrounding it. This type of surgery is only recommended in very rare circumstances and is associated with a long list of complications. 
  • Pleurectomy – the removal of both the inner and the outer lining of the lungs. A less invasive form of surgery also done to address pleural effusions, the removal can be made from an incision in the affected area.This is rarely a curative surgery on its own, however in conjunction with intrapleural chemotherapy some centers have had success in achieving disease-free survival. 
  • Peritoneal Deubulking - This surgery can be either palliative or curative. In the curative setting all residual disease that is visible to the surgeon is removed from the lining of the abdomen (peritoneum). This treatment is rarely effective on its own, and is often used in conjunction with chemotherapy-either systemic or intracavitary- to achieve a cure. 

Palliative: palliative surgery can be proposed to relieve some of the more painful or distressing symptoms of mesothelioma, like chest pain and shortness of breath. Palliative surgeries may include: 

  • Pleurocentesis, also known as thoracentesis – to relieve pain and shortness of breath associated with the buildup of fluid in the pleural cavity. A needle is inserted into the pleural space to withdraw fluid. The patient can often return home after only a few hours. Note that once fluid has been drained once, the build-up of fluid has been known to occur more rapidly. This can be slowed by the insertion of a talc slurry into the pleural space causing it to stick together and close (see pleurodesis below). 
  • Paracentesis – same as above except used to withdraw fluid build-up in the abdominal cavity of patients diagnosed with peritoneal mesothelioma. 
  • Pleurodesis – the insertion of talc into the pleural space to slow the buildup of fluid inside the pleural cavity
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