Several surgical procedures are used to treat mesothelioma. Some mesothelioma surgeries aim to provide a curative effect, while others are performed for palliative purposes (to reduce pain and other symptoms affecting a patient). While treating mesothelioma surgically, a surgeon may remove part of the lining of the chest or abdomen and some of the tissue around it.
In treating pleural mesothelioma, sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed during surgery because the diaphragm is so connected to the pleura (mesothelial lining of the lungs). Depending on how far the cancer has spread, a lung also may be removed (pneumonectomy).
The following are some of the most commonly used surgerical treatments of mesothelioma:
Used to treat pleural mesothelioma, pleurodesis is a surgical procedure that introduces an irritant into the pleural space that creates inflammation. This inflammation effectively eliminates the pleural space, thus preventing fluid build up, or a pleural effusion.
Generally used when the pleural effusion is symptomatic, pleurodesis is a treatment administered through a thoracoscopy or existing chest tube. Talc is used most commonly and effectively for this procedure, thus it is often referred to as "talcing" or as a patient having been "talced."
This procedure is a common reaction to a pleural effusion, but can limit other treatment options. Pleurodesis is best utilized among mesothelioma patients decline other, more aggressive treatment options or who are not candidates for them.
Pleurectomy or Peritonectomy
Surgery to remove part of the chest (pleura) or abdomen lining (peritoneum) and some of the tissue surrounding it. This procedure is performed for a variety of disorders including pleural effusion, malignant mesothelioma, and trauma.
- Malignant peritoneal mesothelioma (abdominal mesothelioma) is sometimes treated surgically with the removal of the peritoneum. In addition to a peritonectomy, tumor debulking or cytoreduction surgery may also be performed to remove cancerous tumor masses.
- Used in cases of malignant pleural mesothelioma, a pleurectomy involves the removal of part of the pleura. Medical literature at times refers to the removal of all or part of the the parietal pleura as a pleurectomy (the parietal pleura is the outer layer of the pleura). Other references to a pleurectomy indicate the removal of both the parietal and visceral pleura. The recent trend seems to be to call removal of both parietal and visceral pleura as a pleurectomy/decortication (see below). The parietal pleura is tightly fused to the diaphram, so some of this muscle may also be removed during surgery.
Decortication is the surgical removal of all or part of the membrane and/or outer layer of an organ. In the case of a lung, this would indicate the removal of the visceral pleura. The visceral pleura is the part of the pleura that touches the lung. The outer part of the pleura, or parietal pleura, is generally removed at the same time, thus a Pleurectomy/Decortication is often
Surgery to remove a lung is known as a pneumonectomy (new-moe-NEK-toe-me). A simple pneumonectomy is the removal of just the affected lung.
Extrapleural Pneumonectomy (or EPP)
In addition to the pneumonectomy (the surgical removal of the lung), an extra pleural pneumonectomy also includes the removal of the pleura, diaphragm, and pericardium (mesothelial lining of the heart).
You can view a web cast from Brigham and Women's Hospital in Boston of this procedure being done by Dr. David Sugarbaker: see the extrapleural pneumonectomy (EPP) web cast here.