Pleurodesis: A Mesothelioma Surgery

Pleurodesis is a mesothelioma surgery used to manage pleural effusions, one of the most common symptoms of malignant pleural mesothelioma. A pleural effusion is a buildup of fluid between the pleural layers. It is normal to have between 10 to 20 milliliters of fluid spread over the parietal pleura, which lines the chest wall, and the visceral pleura, which covers the lungs. This fluid has the same makeup as plasma, except that it contains a lower level of protein. Its job is to create ease of movement between the lung and chest wall.

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Mesothelioma Surgery to Relieve Symptoms

Pleurodesis is the primary form of mesothelioma surgery used to control symptoms of pleural effusions. These include:

  • Uncontrolled fluid build-up
  • Shortness of breath
  • Chest pain

During the procedure, the fluid is completely drained and an irritating agent is injected into the pleural space. This agent causes inflammation, resulting in the development of scar tissue that fills the pleural space so fluid can no longer collect there.

The most commonly used compound for pleurodesis is sterile, asbestos-free talc. It is administered either in powder form or as slurry, meaning the talc is mixed with fluid.

Why Talc in Mesothelioma Surgery?

In a study titled "Talc Pleurodesis - Basic Fibroblast Growth Factor Mediates Pleural Fibrosis", published November 2004 in Chest, researchers from the Division of Pulmonary and Critical Care Medicine of the Department of Medicine at the University of Florida hypothesized that the introduction of talc causes the mesothelial cells of the pleura to produce basic fibroblast growth factor (bFGF), which causes the connective tissue in the pleural space to become thick and scarred.

Pleurodesis Is Not Appropriate for All Pleural Effusions

In cases of mesothelioma where the diseased lung is surrounded by a fibrous peel of tumor, causing it to be trapped, it can no longer expand as it should. In these instances, pleurodesis cannot be performed. Instead, a catheter is tunneled through the pleural space to the abdominal cavity so the fluid can be drained. The patient controls the drainage by means of a manual pump with a one-way valve.

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