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Using Surgery to Treat Malignant Plural Mesothelioma
Surgery is used in a portion of malignant pleural mesothelioma cases in order to remove cancer tissues or address symptoms.
There are two main types of surgery for mesothelioma:
- Surgery that removes portion of the pleura or lungs in order to remove cancer tissues, called “resection” or “debulking” surgery
- Surgery intended to drain fluids from the pleura and treat other symptoms caused by mesothelioma in order to make the patient more comfortable, called “palliative” surgery
Palliative surgery tends to be more common because a high portion of mesothelioma cases are not diagnosed until they have advanced.[1]
Use and Effectiveness of Surgery for Treatment of Mesothelioma
Not every malignant pleural mesothelioma case is an ideal candidate for resective surgery.
Mesothelioma cancers not only tend to be diagnosed at a late stage in their development, but they are also highly invasive.[2] Tumors tend to spread across a large surface area, and they can metastasize to other organs within the body readily.[3]
Because of these qualities, surgical removal of the tumor can often be difficult or impossible when the disease has advanced to later stages. The benefits of surgery at these late stages can include palliative relief, but these benefits can be short-lived.[4] One study showed that debulking surgery can be used as an effective palliative measure, but that it could also result in heightened risk of patient mortality.[5]
However, many forms of mesothelioma can be resectable at stage I and, potentially, at stage II or III. Surgical oncologists have also noted that combining surgery with radiation therapy can reduce the spread of cancer cells and improve the short-term prognosis of patients whose tumors cannot be completely removed by surgery alone.[6]
Patients must consider the side effects along with the possible benefits of surgery for removal of mesothelioma tissue in order to make an informed decision.
Common Surgical Procedures for Malignant Pleural Mesothelioma
There are a number of surgical procedures for malignant pleural mesothelioma that can be used to remove tumorous tissues based on their location, spread, the health of the patient, and other relevant factors.
The most common surgeries for mesothelioma include:
- Wide local excision: An operation where an incision is made and cancerous tissue is removed, along with some of the healthy tissue around it[7]
- Talc pleurodesis: A procedure where pleural fluid is drained and then a medicinal mixture of talc and other substances is applied to close the gap between the patient’s pleura and their chest wall, preventing many recurrent respiratory symptoms[8]
- Extrapleural pneumonectomy (EPP): Removal of the affected lung along with the pericardium (which covers the heart), part of the diaphragm muscle, and a portion of the pleura[9]
- Lung-sparing pleurectomy with decortication (P/D): Removal of the lung’s pleural lining[10] as well as any malignant tissues on the surface of the lung or immediately surrounding organs[11]
[1] https://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/treatment/surgery/?region=on
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543335/
[3] https://ascopubs.org/doi/abs/10.1200/JCO.2017.35.15_suppl.8556
[4] https://www.cancer.org/cancer/malignant-mesothelioma/treating/by-extent.html
[5] https://www.ncbi.nlm.nih.gov/pubmed/11717014
[6] https://www.sciencedaily.com/releases/2019/04/190429125437.htm
[7] https://surgery.ucsf.edu/conditions–procedures/malignant-mesothelioma.aspx
[8]https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pleurodesis
[9] https://www.cancer.gov/publications/dictionaries/cancer-terms/def/extrapleural-pneumonectomy
[10] https://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=476760&version=patient&language=English&dictionary=Cancer.gov
[11] https://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44275&version=patient&language=English&dictionary=Cancer.gov
