Surgery for mesothelioma

Surgery is a medical procedure to examine, remove or repair tissue. Surgery, as a treatment for cancer, means removing the tumour or cancerous tissue from the body.

Most people with mesothelioma have advanced disease when they are diagnosed. This means that there is usually more than 1 tumour and often the cancer has spread along the surfaces of nearby organs, blood vessels and nerves. For these reasons, it can be hard to completely remove mesothelioma with surgery. So surgery is usually done to relieve symptoms and improve quality of life rather than to treat the disease.

You may have surgery to remove as much of the cancer as possible (called debulking surgery) before other treatments. Surgery can also be used to reduce pain or ease symptoms (called palliative surgery).

The type of surgery you have depends mainly on where the mesothelioma started and if it has spread to lymph nodes or other organs. When planning surgery, your healthcare team will also consider other factors, such as your age and your overall heath.

Before any surgery for mesothelioma, your healthcare team will order tests to make sure you are healthy enough to have surgery and recover from it.

Lung function tests are done to see how well your lungs are working. These tests tell the healthcare team if your healthy lung is strong enough to allow you to breathe if the lung with cancer is removed. Find out more about lung function tests.

Heart function tests are done to make sure that your heart is healthy enough to have surgery. Heart problems that can happen during surgery include an irregular heartbeat or a heart attack. The most common heart function tests done before surgery are electrocardiogram (ECG) and echocardiogram.

Blood chemistry tests are done to see how well your kidneys and liver are working. Find out more about blood chemistry tests.

A pleurectomy and decortication or an extrapleural pneumonectomy may be offered as debulking surgeries for pleural mesothelioma. These types of surgery are major operations. They remove as much of the cancer as possible, which means that tissues and organs may be removed as well. This makes it very difficult to recover from these surgeries. Before offering you debulking surgery, your healthcare team will discuss the benefits and risks with you.

You may also be offered palliative surgery to relieve symptoms and improve your quality of life.

A pleurectomy and decortication doesn’t remove as much tissue as an extrapleural pneumonectomy, which means that it has a lower risk of complications. For this reason, it is usually offered to treat pleural mesothelioma. It can also be used to control fluid buildup in the chest, improve breathing and reduce chest pain in people with more advanced disease.

A pleurectomy and decortication removes the parietal pleura and the visceral pleura. But it doesn’t remove the lung on the side of the chest where the mesothelioma is. An extended pleurectomy and decortication will also remove the membrane that surrounds the heart (called the pericardium) and part of the diaphragm.

This surgery is done through a large cut (incision) in the side of the chest (called a thoracotomy). The surgeon will place tubes in the chest to drain fluid from the area where the surgery was done. This helps the lungs work properly and the body heal. The healthcare team will remove the tubes when all the fluid is drained from the chest.

People with stage 1 or 2, and some people with stage 3, pleural mesothelioma may be offered an extrapleural pneumonectomy. The healthcare team will only offer this type of surgery if they think the cancer is resectable, which means that most or all of it can be removed. If mesothelioma has spread to the diaphragm, this surgery is not usually offered.

An extrapleural pneumonectomy removes the parietal pleura and the visceral pleura, the lung on the side of the chest where the mesothelioma started, part of the diaphragm and the lymph nodes in the chest. The membrane surrounding the heart (called the pericardium) may also be removed.

This surgery is done through a thoracotomy. After all the tissue is removed, the surgeon will use a special material to repair the diaphragm, as well as the pericardium if needed.

The surgeon will place tubes in the chest to drain fluid from the area where the surgery was done. This helps the remaining lung work properly and the body heal. The healthcare team will remove the tubes when all the fluid is drained from the chest.

Palliative surgeries don’t treat pleural mesothelioma. But they can be used to relieve symptoms, such as pain or difficulty breathing.

Pleurodesis is done to treat and prevent fluid buildup on the lungs (pleural effusion). The surgeon will place a chest tube to drain extra fluid from the space between the lungs and the wall of the chest (called the pleural space). Then a chemical called talc is put into the pleural space to seal the parietal and viseral pleura together. This prevents the fluid from building up again.

Thoracentesis can also be done to treat pleural effusion. The surgeon passes a thin, hollow needle through the skin, between the ribs, through the chest wall and into the pleural cavity. The fluid is then drawn out through the needle. Thoracentesis may need to be repeated if the fluid builds up again. Find out more about thoracentesis.

Image-guided thermal ablation may be done to control the growth of pleural mesothelioma. It is a type of surgery that uses extreme heat or cold to destroy cancer cells. The doctor uses ultrasound, MRI or CT scan to guide a needle through the skin and into the tumour. A current passes through the needle to freeze or burn the area to destroy cancer cells.

Peritoneal mesothelioma is often diagnosed after it has spread too much for it to be completely removed with surgery. So surgery is often used to relieve symptoms and improve quality of life rather than to treat the cancer itself.

People with peritoneal mesothelioma may be offered debulking surgery to remove as much of the cancer as possible. During debulking surgery, the lining of the abdomen (peritoneum) is removed. This is sometimes called a peritonectomy. Other tissues and organs may also need to be removed, such as part of the colon, the gallbladder, the spleen or the appendix. The part of the visceral peritoneum that covers the organs in the abdomen (called the omentum) may be removed as well. This is because peritoneal mesothelioma often spreads to the omentum.

Chemotherapy drugs may be put into the abdomen after debulking surgery is finished and before the cut is closed. This is called intraperitoneal chemotherapy. If the chemotherapy drugs are heated before they are put in the abdomen, it is called hyperthermic intraperitoneal chemotherapy.

Peritoneal mesothelioma often causes fluid buildup in the abdomen( called ascites). Removing this fluid can relieve symptoms, such as abdominal swelling and shortness of breath.

During paracentesis, the doctor inserts a hollow needle or tube (catheter) through the skin and into the abdominal cavity. The extra fluid is then drained through the needle or catheter. Paracentesis may have to be done several times because fluid often builds up in the abdomen again.

Find out more about paracentesis.

Side effects of surgery will depend mainly on the type and site of surgery and your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

The types of surgery used for pleural mesothelioma may cause these side effects:

• rib pain
• problems breathing, such as shortness of breath
• bleeding
• a collection of pus in the chest (called empyema)
• collapsed lung (called pneumothorax)
• heart problems, such as an abnormal heartbeat or a heart attack (the risk for heart problems is higher after an extrapleural pneumonectomy)

Surgery for peritoneal mesothelioma may cause these side effects:

• a bowel obstruction (the small intestine or colon is partly or completely blocked)
• a bowel perforation (a hole in the wall of the small intestine or colon)

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.