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Mesothelioma Surgery

In a study titled Surgical Treatment of Malignant Pleural Mesothelioma published online April 5, 2011 in Current Treatment Options in Oncology, authors Andrew Kaufman and Raja Flores note that even though surgery is an accepted form of treatment for pleural mesothelioma, controversy still exists as to whether it really does increase change of survival and whether extrapleural pneumonectomy or pleurectomy/decortication is more effective in increasing those chances.

The problem, as the explain it, is that there are no randomized clinical trials comparing extrapleural pneumonectomy and pleurectomy/decortication, which means that there isn’t a lot of evidence to support either technique.
The two operations are quite different. 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 decortication is the surgical removal of the pleura that covers the diseased lung; however, the lung remains intact.

An extrapleural pneumonectomy is far more radical in its approach because the diseased lung is removed along with the pleura the 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.

The authors added, however, that in spite of the controversy over techniques, there is agreement as to the goal of 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, and the extent of planned adjuvant (secondary) therapy.”

Mesothelioma Surgery for Peritoneal Mesothelioma

This form of 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, published online March 29, 2011 in Current Treatment Options in Oncology, 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 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.

This combination of surgery and HIPEC can be used alone, or in combination with abdominal chemotherapy administered after the surgery, or as part of a multi-modality therapy that includes surgery/HIPEC and abdominal chemotherapy and radiation of the whole abdomen administered after surgery.

Mesothelioma Surgery Achieves Good Outcomes in Some Patients

According to these 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, 60 years old or younger, and the complete removal of the disease. In patients with ascites, or a buildup of fluid in the abdominal cavity, complete alleviation of this symptom is achieved in almost all cases. However, this treatment regimen carries substantial risk. The chance of developing another medical condition is 25 percent and there is a seven percent risk of dying.

“Despite these risks, the best overall survival data have been associated with this surgical approach.”

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