Mesothelioma Surgery
A diagnosis of Mesothelioma from fluid is many times inconclusive. Given this fact, diagnostic surgery becomes a necessary next step in confirming and staging Mesothelioma.
Thoracoscopy enables a physician to evaluate the pleural cavity and to conduct multiple tissue biopsies under direct vision. In up to 98% of cases, a definitive diagnosis can be obtained. Often, chemical pleurodesis aimed at relieving the accumulation of fluid in the extrapleural space, can be accomplished during the same procedure. It is also possible to gauge the extent of the tumor, and make a determination of surgical respectability. While less invasive than an open biopsy, it can only be performed on patients where tumor has not obliterated the pleural space.
VATS, or video-assisted thoracic surgery is an alternative to thoracoscopy, although because of its more invasive nature, concerns of tumor seeding increase. By utilizing small incisions, the physician can view the pleural space with the assistance of a camera, and obtain sufficient tissue samples for analysis by a pathologist. Extent of the tumor (i.e., pleural involvement, chest wall invasion) may also determine, and recommendation as to the type of debunking procedure necessary can be made at this time.
Mediastinoscopy is sometimes used as an aid in staging extent of disease when enlarged nodes are seen using imaging techniques.
Laproscopy is used in Mesothelioma patients in cases where imaging techniques suggest possible invasion of the tumor through the diaphragm. This information can be important in evaluating a patient for potential pleurectomy or extrapleural pneumonectomy.
Pleurectomy:
The most common surgery for Mesothelioma treatment is pleurectomy, in which doctors open the patient's chest and remove the excessive fluid or tumor from the lining of the lungs (pleura). Although this procedure controls the accumulation of fluid and decreases pain, it still is not a cure. On the other hand, if the tumor is in its initial form and has not extensively grown, a pleurectomy can increase the survival rate of a patient when combined with chemotherapy and radiation. Additionally, a pleurectomy can be performed on patients with less-approving health conditions and has lower mortality rate than the extrapleural pneumonectomy.
Extrapleural Pneumonectomy (EPP):
Extrapleural pneumonectomy (EPP) is an invasive and severe form of surgery conducted on patients with Mesothelioma. In this treatment, parts of the lungs, the pleura (the lining of the lung), the pericardium (lining of the heart) and the hemi-diaphragm, along with the tumor cells, are removed. It decreases the progression of Mesothelioma, while allowing a patient to breathe smoothly. It is usually conducted on patients with early stages of the cancer and when the tumor is in chest cavity. EPP is recommended for patients with good heart and lungs conditions, in order to endure the severities of the post-operative term. Though the surgery combined with chemotherapy and radiation gives promising results, it does not guarantee a cure. Researches have shown that patients treated with extrapleural pneumonectomy and therapies have a medium life span of 35 months after the surgery, compared to only 9 months of pleurectomy. Still, some doctors question the surgery for its high risks, which include internal bleeding, blood clotting, pneumonia, amassing of pus, respiratory failure and even death. Thus, many surgeons recommend the idea of pleurectomy instead of the technically complicated EPP.
Thoracentesis:
A minor surgery is often conducted on patients who cannot undergo EPP or pleurectomy, called Thoracentesis. In Thoracentesis, a thoracic surgeon inserts a needle into a patient's chest to remove the excessive fluid built up in the lining of the lungs (pleura). This method neither cures nor decreases the cancer, but rather alleviate the painful symptoms of Mesothelioma. In some cases, talc or other agents are infused into a patient's chests to scar the chest wall and help them breathe properly without letting the tumor to increase, to some extent.
Paracentesis:
Paracentesis is a similar method of using a needle to extract fluid, but from the abdominal section of the body. It follows the same procedure of extracting fluid from the lining of the stomach or other abdominal organs. Patients with peritoneal Mesothelioma can benefit from Paracentesis surgery.
