4) Surgery
Surgical treatment of mesothelioma is an important treatment modality, although it isn’t always necessarily successful in curing the disease. The two operations most commonly used in this tumor are pleurectomy with decortication and extrapleural pneumonectomy. Before either of these is carried out the patient’s health must be thoroughly assessed to determine if he/she will be able to tolerate the procedure. It should also be restated that an early diagnosis increases the chances of a successful treatment, especially with surgery. A tumor that is discovered late may very well have metastasized to other bodily organs, rendering surgery less useful. The two surgical procedures will be described in some detail below.
Pleurectomy with decortication is an operation consisting of two parts. Before starting, the patient is put under general anesthesia, and is positioned on his/her side to allow the surgeon to reach the tumor with the least amount of difficulty. The surgeon makes an incision called a thoracotomy, which is a long incision that extends from the back of the patient then curves along the ribs. The scalpel cuts through the skin, subcutaneous tissue and chest muscles to reach the pleural cavity. Once there, the surgeon removes the outer layer of pleura, called the parietal pleura. This is the first step of the procedure and is what we call a pleurectomy. It may or may not be combined with the removal of other structures, such as the diaphragm or the serous sac covering the heart, which is called the pericardium. Then, the surgeon removes as much tumor tissue as possible from the lungs and chest area. This is the second step of the operation, which is called a decortication.
The other surgical operation that can be used in the treatment of a malignant mesothelioma is what is known as an extrapleural pneumonectomy. Here again the patient is put under general anesthesia and laid down on his/her side which is the optimal position for this surgery. The surgeon makes a long incision similar to the one used in a pleurectomy with decortication but when the lungs are reached, a much more extensive dissection is done. Not only is the pleura and pericardium removed, but the patient’s entire diseased lung is excised. Part of the diaphragm (the horizontal muscular structure below the lungs) may also be removed. This advanced degree of dissection makes an extrapleural pneumonectomy more risky and thus less commonly carried out in comparison to a pleurectomy with decortication. However, some patients may need an extrapleural pneumonectomy to control an advanced, invasive malignant mesothelioma that wouldn’t have been controlled by the less rigorous pleurectomy with decortication.
As more and more advances are made in medical tech, the surgeries can more easily be performed not by huge incisions but by using small cameras and tubes called laparoscopes. This severly cuts down on the recovery time and reduces the risk of accidentally injuring a structure in the chest cavity that shouldn’t have been involved in the operation.
A mesothelioma affecting the abdominal cavity can be treated by removing the peritoneal lining. Likewise, a mesothelioma around the heart can be managed by a surgical removal of the pericardial sac.
