Currently, surgery as part of a multi-modality mesothelioma treatment that includes chemotherapy and radiation offers the best chances for survival. Mesothelioma surgery alone, on the other hand, may not work to increase survival outcomes in any meaningful way, according to recent research. The type of mesothelioma surgery performed may also have an impact on survival rates, but it isn't currently clear which type of surgery has the best outcomes overall. The problem is that there are no randomized clinical trials comparing mesothelioma surgery techniques.
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Types of Mesothelioma Surgery
A pleurectomy/decortication is a two part procedure. The first part involves the surgical removal of the pleura that lines the chest wall and the pleura over the sac around the heart, the cavity between the lungs and the diaphragm. The second part, decortication, is the surgical removal of the pleura that covers the diseased lung.
An extrapleural pneumonectomy is far more radical in its approach because the diseased lung is removed along with the pleura that lines the chest wall, the pleura that covers the lung, lymph nodes in the cavity between the lungs, the sac around the heart and most of the diaphragm.
There is agreement as to the goal of the two types of mesothelioma surgery, which is complete removal of the tumor if possible, or at least removal of as much of it as can be removed to make chemotherapy and radiation more effective. How this is accomplished depends on multiple factors including:
- Disease stage
- The patient's cardiopulmonary reserve
- Surgeon experience and philosophy
- The extent of planned secondary therapies
Mesothelioma Surgery for Peritoneal Mesothelioma
Peritoneal mesothelioma originates in the abdominal cavity and its progression is primarily in that area. Given this characteristic of the disease, the treatment is designed to control progression in the abdominal cavity.
In a study titled Surgery for Peritoneal Mesothelioma, authors Keli M. Turner, Sheelu Varghese and H. Richard Alexander note that the treatment most commonly used is removal of as much of the tumor as possible along with what is called hyperthermic intra-operative perfusion of intraperitoneal chemotherapy (HIPEC).
The HIPEC procedure is performed directly following the tumor removal. For a maximum of two hours, a sterile solution containing a chemotherapy drug that is heated to a temperature above the normal body temperature is circulated in the abdominal cavity. The purpose is to destroy any disease that was not removed surgically.
Mesothelioma Surgery Can Achieves Good Outcomes
According to the above authors, there have been instances of patients surviving for up to seven years after the surgery/HIPEC procedure. Factors that influence a good outcome include:
- Being female
- Being 60 years old or younger
- The complete removal of the tumor
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