A “resectable” mesothelioma is one that can be removed by surgery. Most Stage 1 pleural mesotheliomas are resectable. A “non-resectable” or “unresectable” mesothelioma is one that has spread too far to be completely removed by surgery. Stage 4 pleural mesotheliomas are not resectable. Some Stage 2 and Stage 3 mesotheliomas are resectable, some are not.
Surgery for mesothelioma may be “potentially curative” or it may be “palliative”. 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. Palliative surgery may be performed for unresectable mesotheliomas to relieve some of the more painful or distressing symptoms of mesothelioma, like chest pain, shortness of breath, and pleural effusions (a build-up of excess fluid in the layers of tissue that line the lungs and the chest cavity) .
Potentially curative surgical options for the removal of mesothelioma 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 and Decortication– the removal of both the inner and the outer lining surrounding 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, when offered in conjunction with intrapleural chemotherapy, some centers have had success in improving disease-free survival.
- Peritoneal Debulking – the removal of all residual disease that is visible to the surgeon 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. This surgery can be either palliative or curative.
Palliative surgical options 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. One side effect of this procedure is that fluid can build up again more rapidly. This fluid build-up can be slowed by pleurodesis (see below). For patients with recurrent pleural effusion, some cancer centres offer a procedure that involves putting a catheter into the chest so that patients can drain the fluid themselves.
- Paracentesis – same as pleurocentesis except used to withdraw fluid build-up in the abdominal cavity of patients diagnosed with peritoneal mesothelioma. For patients with recurrent peritoneal effusion, some cancer centres offer a procedure that involves putting a catheter into the peritoneal cavity so that patients can drain the fluid themselves.
- Pleurodesis – the insertion of talc into the pleural space to slow the buildup of fluid inside the pleural cavity.
Regardless of whether it is performed for a curative or a palliative intent, surgery is a serious undertaking and should only be performed by a surgeon with significant experience and expertise in mesothelioma.