Malignant Mesothelioma: Surgery
Surgery can sometimes be used to treat mesothelioma. Different kinds of surgery may be done. Which type you have depends on where the cancer is, how much it has spread, and other factors.
When might surgery be used for mesothelioma?
Surgery is sometimes done to try to remove all of the cancer if it has not yet spread to other parts of your body. However, it’s often hard to remove it completely. For more advanced cancers, surgery can also sometimes be used to help prevent or relieve symptoms from the cancer.
If your healthcare provider suggests surgery, be sure you understand the goal of the operation. Ask if it’s to try to cure the cancer or if it’s being done with a different goal. Surgery for mesothelioma is a complex operation. It can have major side effects. So, it’s important that you understand the risks and are healthy enough for surgery. It’s also crucial to have surgery done at a center that has experience treating this cancer.
Types of surgery for mesothelioma
Surgery to remove pleural mesothelioma
Extrapleural pneumonectomy (EPP)
In this operation, the surgeon removes the lung, the lining of the lung and chest wall (pleura), and part of the thin muscle that separates the chest from the abdomen (diaphragm). He or she also takes out the lining around the heart (pericardium) and nearby lymph nodes. This extensive operation offers the best chance to remove all of the cancer. But it can also have serious complications.
This is a less extensive operation. In it, parts of the pleura around the lung and lining the chest wall and diaphragm are removed. But the lung is not. Sometimes parts of the pericardium or diaphragm are also removed.
For some mesotheliomas in the chest or abdomen, a less extensive operation might be done to remove as much visible tumor as possible. This is done when surgery is unlikely to cure the cancer. This is often combined with other treatments, such as chemotherapy (chemo). The goal here is to help a person live longer. It’s also to prevent or relieve symptoms from the cancer.
For more advanced cancers, sometimes other procedures can help with symptoms. For instance, mesothelioma often causes fluid to build up in the chest. This can cause trouble breathing.
In this procedure, a long, hollow needle is put into the chest to remove the fluid. This might need to be done again if the fluid comes back. Sometimes a thin tube (catheter) is used to remove the fluid. One end stays in the chest, while the other stays outside the body attached to a special bag or bottle to collect the excess fluid. Another option might be to place a small tube (shunt) into the body during surgery. This allows the fluid to move from the chest to the abdomen, where it is less likely to cause problems.
This procedure is done to prevent fluid from building up again in the chest. After the fluid is drained, your healthcare provider uses a tube to put a substance into your chest. These can include talc or a chemo drug. This causes the lining of the lung and the chest wall to stick together. This can help prevent the further buildup of fluid.
Possible risks, complications, and side effects of surgery
All surgery has risks. Some of the risks of any major surgery include:
Reactions to anesthesia
Blood clots in your legs or lungs
Damage to nearby organs
Risks from surgery for mesothelioma
Along with the risks above, esophageal surgery can sometimes cause other problems. These can include:
Pneumonia. Some people have lung problems after surgery. This can lead to pneumonia.
Trouble breathing. This can be a problem is a lung is removed or if fluid continues to build up in your chest.
Getting ready for your surgery
Before you go for surgery, you’ll meet with your surgeon to talk about it. At this time, you can ask any questions and discuss any concerns you may have. This is also a good time to review the side effects of the surgery and to talk about its risks. You might ask if the surgery will leave scars and what those scars will look like. You might also want to ask when you can expect to return to your normal activities. After you’ve discussed all the details with the surgeon, you’ll sign a consent form that says that the doctor can do the surgery.
A few days before your surgery, your doctor might prescribe laxatives and enemas to help clean out your colon. Your doctor will tell you when and how to use these. You may also be told to follow a special diet.
On the day of your surgery, you should arrive at the hospital admission area a couple of hours early. There, you'll complete the needed paperwork and then go to a preoperative area. In this area, you’ll undress and put on a hospital gown. During this time, your healthcare team will ask you about your health history and drug allergies. They will also talk about the surgical procedure. These questions are repeated to help prevent mistakes.
While you’re in the preoperative area, an anesthesiologist or a nurse anesthetist will do an evaluation. They’ll also explain the anesthesia you will have during your surgery. The purpose of the anesthesia is to put you to sleep so that you won't feel any pain during the operation. Be sure to answer all the questions thoroughly and honestly. This will help prevent complications. Also, ask any questions you have regarding your anesthesia because you’ll sign a form that states that you understand the risks involved.
Your surgeon will see you in the preoperative area. You can ask any last-minute questions you have. This will help put your mind at ease.
What to expect during surgery
When it’s time for your surgery, you’ll be taken into the operating room. There will be many people there. These include the anesthesiologist, surgeon, and several nurses. Everyone will be wearing a surgical gown and a face mask.
Once in the room, medical staff will move you onto the operating table. There your anesthesiologist or nurse will place an intravenous line (IV) into your arm. This requires just a small skin prick. Someone will place special stockings on your legs to help prevent blood clots. EKG wires with small, sticky pads on the end will be attached to your chest. These monitor your heart. A blood pressure cuff will also be wrapped around your arm. When all the preparation is done, you’ll receive the anesthetic through the IV and will fall asleep.
During surgery, a Foley catheter may be placed through your urethra and into your bladder. This is a hollow tube used to drain urine. You’ll also have a breathing tube placed in your windpipe. A breathing machine (ventilator) will control your breathing. Also, a nasogastric tube may be placed in your nose. This is a suction tube that extends into the stomach to drain stomach contents.
What is removed during surgery and where your incisions are depend on the type of surgery you have. This is based on where the tumor is.
After your surgery is done, medical staff will move you to the recovery room. There, they will watch you for another hour or two. When you wake up, don't be alarmed by the number of tubes and wires attached to you. These are normal monitors for after surgery. When you’re fully awake in the recovery room, your family will be able to see you for a short time. Once you’re awake and stabilized, the staff will transfer you to the regular hospital floor.
What to expect after surgery
When you first wake up, you might have some pain. Your doctor or nurse will give you pain relievers as needed. These can help you feel more comfortable. The pain medicines will also help you get up and walk the day after your surgery. This is important for your recovery.
It will take you time to get back to eating normally and having regular bowel movements. You will still have the Foley catheter in your bladder to drain urine. It allows your healthcare providers to measure your urine output and keep track of your fluid status. It’s normally removed before you go home.
How long you stay in the hospital will depend on the type of surgery you have. You can slowly return to most normal activities once you leave the hospital. But you should avoid lifting heavy things for several weeks. Always follow the instructions you get from your healthcare team.
After surgery, you may feel weak or tired for a while. The amount of time it takes to heal from an operation is different for each person. You may not feel like yourself for several months. Your healthcare providers will give you instructions about whether and when you can get your incisions wet. You likely won't be able to drive for a while, as directed by your healthcare providers.
Talk to your healthcare team
If you have any questions about your surgery, talk to your healthcare team. They can help you know what to expect before, during, and after your surgery.
March 21, 2017
Initial Management of Malignant Pleural Mesothelioma. UpToDate., Management of Malignant Pleural Effusions. UpToDate.
Alteri, Rick, MD,Levin, Mark, MD