Monday, December 22, 2014

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Surgery for malignant mesothelioma

Surgery for mesothelioma may be done for 1 of 2 reasons:
  • To try to cure the cancer
  • To relieve (palliate) pain and other symptoms caused by the tumor
Surgery to try to cure the cancer is known as potentially curative surgery. This type of 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 is not likely to cure you but may extend your life. Still, potentially curative surgery is being done in some major cancer centers, and a small number of patients 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 is difficult 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

Surgery for pleural mesothelioma may 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 may 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 is 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. 

This operation 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 done only by surgeons in large medical centers. You must be in good overall health with good lung function and no other serious illnesses to tolerate this surgery. Several tests must be done beforehand to be sure you are healthy enough for this surgery. Major complications 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 pericardium are removed as well. 

This surgery can be used to try to cure some early cancers, but it is also used as a palliative procedure to relieve symptoms in cases where the entire tumor cannot be removed. It can help control the buildup of fluid, improve breathing, and decrease pain caused by the cancer. 

Debulking: 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.

Possible side effects of surgery: Possible risks and side effects depend on the extent of the surgery and the person’s health beforehand. Serious complications of EPP can include bleeding, blood clots, wound infections, changes in heart rhythm, pneumonia, and loss of lung function. Most of these are less common with less extensive operations.

Because the surgeon must often spread the ribs during surgery, the incision will hurt for some time afterward. Your activity will be limited for at least a month or two.

Surgery for peritoneal mesothelioma

Surgical treatment of peritoneal mesothelioma is often 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.

After the cancer is debulked (but before the patient is sewn up), chemotherapy may be given into the abdominal cavity. 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 a short time, and the patient is sewn up after they are removed.

Omentectomy: The omentum is an apron-like layer of fatty tissue that drapes over the contents inside the abdomen. Cancers in the peritoneum often spread to this tissue, so it may be removed as part of surgery for peritoneal mesothelioma.

Surgery for pericardial mesothelioma

Surgery can remove a mesothelioma from the pericardium (the sac around the heart).

Surgery for mesothelioma of the tunica vaginalis testis
Surgery for mesothelioma of the tunica vaginalis testis, which occurs in the groin, rarely cures this cancer. Most of the time surgery is done because the tumor resembles a hernia. The surgeon attempts to treat a suspected hernia and only realizes the diagnosis after the surgery has begun. This kind of mesothelioma typically can't be removed entirely.


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Aqeel A. Zaman