This involves removal of some or all of the affected lung. It is curative or palliative.
A lengthy incision is made to access the affected lung. It is collapsed and then removed. Sometimes, the fifth rib is removed in order to make it easier to access the lung. The incision is then closed and dressed. The surgery has a very high rate of success.
Risks include prolonged breathing difficulties, penumonia, pulmonary embolism, kidney failure, and heart attack.
Extrapleural pneumonectomy (EPP)
The lung, pleura, a part of the diaphragm, the pericardium and regional lymph nodes are removed. The surgery was introduced in the late 1940s at a treatment for tuberculosis and can be a curative or palliative treatment for pleural mesothelioma.
Extrapleural pneumonectomy is a more invasive procedure that involves removing all or as much of the cancerous tissue as possible. An incision is made to expose the pleura, then tumors are removed. Because a part of the diaphragm and the whole pericardium are removed, they are replaced with synthetic implants.
Because of how extensive the surgery is, the risks involved, a rather high complication rate, and a slow recovery, EPP has become less popular in recent years. Risks include infection, kidney failure, pneumonia, heart attack, blood clots and excess fluid in the lungs. Complications can be fatal.
The pleura on the affected side is removed. A more extensive version of P/D includes removal of the diaphragm and/or pericardium (which are replaced with synthetic implants). It can be curative or palliative.
The surgery involves making an incision to make the chest cavity accessible. The affected pleura is removed along with any tumors. The incisions are then closed and dressed. The success rate of P/D is relatively high.
P/D is a surgical technique that is less traumatic than EPP. When combined with chemotherapy, it was actually described as being “superior”1. Patients may find results to be curative, or at least experience a decrease in the severity of their symptoms. P/D can help improve breathing ability, minimize pain and control the amount of fluid that may build up in the pleural lining. Their lifespan may also be extended.
Risks include penumonia, infection, blood clots, cardiac failure and collapsed lung.
Peritonectomy and cytoreduction
The peritoneum (abdominal lining) is removed. This is a palliative or curative treatment for peritoneal mesothelioma.
Surgery begins with an incision in the abdomen to remove cancerous tissue. A portion of the bowels, gall bladder, liver, pancreas, spleen and stomach may be removed in the process. “Debulking”, another term for cytoreductive surgery, is then performed. This involves applying chemotherapy directly to the affected area to destroy cancer cells. The drugs may be heated, in which case it is called heated intraoperative chemotherapy.
Risks include pain, infection, hyperthermia and pulmonary thromboembolism.
Excess fluid is drained from the pleura (pleural effusion) with a needle or plastic tube. It is usually performed for palliative or diagnostic reasons for pleural mesothelioma.
Thoracentesis can help reduce the pressure on the lungs, making it easier to breathe. The procedure takes about 15 minutes or so to perform. First, an x-ray of the chest is taken to determine how much fluid buildup there is and pinpointing where the needle should enter. Local anesthesia is administered then a needle is inserted between the ribs to drain the pleural effusion. An ultrasound or CT imaging may be used to help guide the needle into the right place. Once some or all the fluid is removed, the needle is withdrawn and the puncture point is dressed. Another x-ray may be performed to see how much fluid was removed and ensure that the lungs are functioning.
The obtained fluid is sent to the lab for testing. Doing so can help you find out if you are suffering from another condition, such as pancreatitis, lung infection or pulmonary embolism.
Risks include collapsed lung (pneumothorax), excessive pain, bleeding bruising, infection and injury to the liver or spleen.
Paracentesis and pericardiocentesis are similar procedures designed to remove excess fluid in the peritoneal cavity and the pericardium respectively.