Surgery for mesothelioma may be done for 2 reasons:
• To try to cure the cancer (potentially curative surgery)
• To relieve pain and other symptoms caused by the tumor (palliative surgery)
Potentially Curative Surgery may be an option if you are in otherwise good health and the cancer has not spread too far to be removed completely. Unfortunately, even when the surgeon can remove all of the cancer that can be seen, some cancer cells are often left behind. These cells can grow and divide, causing the cancer to come back after surgery. Because of this, not all doctors agree on the exact role of surgery. In most cases it’s not likely to cure you, but it may help you live longer. Still, potentially curative surgery is being done in some major cancer centers, and a small number of people who have had the surgery have had long remissions of their disease.
Palliative Surgery may be an option if the tumor has already spread beyond where it started and would be hard to remove completely, or if you are too ill for a more extensive operation. The goal of this surgery is to relieve or prevent symptoms, as opposed to trying to cure the cancer.
Surgery for pleural mesothelioma can be done either to help prevent or relieve symptoms or to try to remove all of the cancer. Unfortunately, these tumors often have spread too far to be removed completely. Sometimes, the surgeon might not be able to tell the full extent of the cancer – and therefore which type of surgery might be best – until the operation has started.
Extrapleural pneumonectomy (EPP): This is an extensive operation, but it may offer the best chance to remove all of the cancer for many patients. It’s most often used when the surgeon thinks a cure is possible – typically in patients with resectable epithelioid mesothelioma that has not spread to the lymph nodes.
In this operation, the surgeon removes the lung on the side of the cancer along with the pleura lining the chest wall on that side, the diaphragm on that side, the pericardium (the sac around the heart), and nearby lymph nodes. The diaphragm and the pericardium are then reconstructed with man-made materials.
This is a difficult operation that is done only by experienced surgeons in large medical centers. You must be in good overall health with good lung function and no other serious illnesses to withstand this surgery. Several tests must be done beforehand to be sure you’re healthy enough for this surgery. Major complications can occur in as many as 1 in 3 people who have this operation.
Pleurectomy/decortication (P/D): This is a less extensive operation in which all of the pleura lining the chest wall (on the side with the cancer) is removed, along with the pleura coating the lung on that same side. The pleura coating the mediastinum and the diaphragm is also removed. The lung and diaphragm are not removed.
In a slightly more extensive version of this operation (known as a radical or extended P/D), the diaphragm and/or pericardium are removed as well.
This surgery can be used to try to cure some early cancers, but it can also be used as a palliative procedure to relieve symptoms if the entire tumor can’t be removed. It can help control the buildup of fluid, improve breathing, and lessen pain caused by the cancer.
Debulking (partial pleurectomy): The goal of this surgery is to remove as much of the mesothelioma as possible. In general, less tissue is removed in this operation than in a P/D procedure.
Surgical treatment of peritoneal mesothelioma can be done either to help relieve symptoms or to remove the tumor from the wall of the abdomen and digestive organs. As is the case with pleural mesothelioma, these tumors often have spread too far to be removed completely.
Debulking: The goal of this surgery is to remove as much of the mesothelioma as possible. Sometimes this means removing pieces of the intestine as well.
After the cancer is debulked (but before the operation is finished), chemotherapy may be given into the abdomen. This is called intraoperative chemotherapy. If the chemotherapy drugs are heated, it is called heated intraoperative (or intraperitoneal) chemotherapy or HIPEC. In either treatment, the drugs are left in for a short time, and the incision is closed after they are removed.
Omentectomy: The omentum is an apron-like layer of fatty tissue that drapes over the organs inside the abdomen. Cancers in the peritoneum often spread to this tissue, so it may be removed as part of surgery for peritoneal mesothelioma.
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