Mesothelioma Treatment – Surgery

Malignant Mesothelioma Treatment Surgery

Surgery is not claimed to be a cure for malignant mesothelioma, so therefore it comes down to a valued judgement of whether there is a chance it will potentially extend survival time along with quality of life, significantly enough to warrant taking the risk on having it.  All radical surgery has an element of risk, only the person having the surgery is in the position of making the final decision on whether to have it or not.

If you have been diagnosed with malignant mesothelioma it is imperative that a specialist conversant in mesothelioma be consulted, to help you work out a pathway to navigate the journey ahead.

Surgery for the treatment of Malignant Mesothelioma, other than pleurodesis, are generally thought of as being radical or aggressive surgeries, and are only deemed suitable for a very small proportion of sufferers.

Radical surgery is normally only judged as being suitable for relative fit sufferers, as the operation itself, and the recovery can be painful and lengthy.  Malignant Pleural Mesothelioma (MPM) radical surgery has the added trauma of the need to cut through, or stretch the protective rib cage, which adds further to the recovery period.  Radical surgery for both peritoneal and pleural mesothelioma is normally carried out in conjunction with chemotherapy and/or radiotherapy – this is called multimodality or trimodality treatment.

A literature search [see Study #1 further down the page] of studies on the value of MPM sufferers having a Talc Pleurodesis (which is not considered to be aggressive surgery) compared to more aggressive surgeries have shown the average age of sufferers having aggressive or radical surgery to average between 57.5 years to 60.9 years.  This would suggest, and backs experience that age is also an important factor in the viability of a sufferer considering having aggressive or radical surgery.

Surgery is not considered to be a cure for malignant mesothelioma, and as such a sufferer and their loved ones need to carefully weigh up the pros and cons of having surgery against quality of life factors.

When trying to decide on whether or not to undertake radical surgery, considering the time in hospital and the recuperation period after having aggressive surgeries, should be factored into the quality of life equation and the perceived benefits to be received from having aggressive surgery.  It really is a decision that needs to be made on a fully informed individual basis.  Please take the time to read all the information on this page and download and read the Questions to answer regarding Surgery pdf document.

“I do not believe my role is to sway people, but rather to assist people to make informed decisions.  I believe the mesothelioma journey should be all about quality of life, first and foremost.  But what constitutes quality of life for one person, is totally different for another.  It is why I talk a lot about making informed life decisions, so at the end of any journey a person has no regrets.  To this end I have compiled information on the pleurodesis surgery and radical surgery options.  I have also put together a list of questions I suggest you ask a perspective surgeon prior to considering radical surgery as an option.”   – Rod Smith

Before committing to any form of surgery please consider:

• The pros and cons of each particular surgery;
• The questions to ask, and get answers from, the surgeon involved; and
• What to look for and talk about before making what can only be described as a major life decision.

This page covers the following:

Malignant Pleural Mesothelioma Surgery

• Pleurodesis
• Pleurectomy/Decortication [P/D]
• Extra Pleural Pneumonectomy [EPP]

Malignant Peritoneal Mesothelioma Surgery

• Peritonectomy (also known as Cytoreductive) Surgery
• Heated Intraperitoneal Chemotherapy

Why you should question a surgeon

Video Covering Malignant Pleural Mesothelioma and Applicable Surgeries

Questions To Ask The Surgeon When Discussing Radical Surgery

Analytical Studies on Malignant Mesothelioma Surgery – August 2017

• [Study #1] Review of Malignant Pleural Mesothelioma Survival After Talc Pleurodesis or Surgery
• [Study #2] Factors Associated With Survival In A Large Series of Patients With Malignant Pleural Mesothelioma in New South Wales
• [Study #3] Long-Term Survival Outcomes of Cancer-Directed Surgery for Malignant Pleural Mesothelioma

Point to ponder – and further reasons to question a surgeon

Supportive Care Options

Malignant Pleural Mesothelioma Surgeries

VAT Talc Pleurodesis

Video-assisted thoracoscopic Talc Pleurodesis is perhaps the most common form of treatment used for treating MPM – it is not considered radical, or major surgery as it is performed using keyhole surgery techniques.  It is quite often carried out at the same time as performing a tissue biopsy to identify if a sufferer has MPM.  This is particularly the case if scans show a build up of fluid in the chest cavity.  It involves inserting a form of talcum powder into the pleura (a two layered serous membrane that is the outer lining of the lung, and is attached to the internal chest wall) to stick both layers of the pleura together.

The intention of a pleurodesis is to prevent the re-accumulation of fluid in the pleural space – this is important, as fluid build up causes expansion of the pleural space, which creates less space for the lungs to expand in the chest cavity.  This procedure alleviates the symptoms, whilst it does not cure or correct the cause, it may assist to slow the growth of cancerous tumours.  If successful, a pleurodesis will normally allow a sufferer to breathe easier and have a better quality of life.

Whilst a relative minor operation it can cause discomfort and/or nerve type pain as a result of the fairly robust splitting or pulling of the linings, which could last for some weeks.  It is not unusual to be in hospital anywhere from four days up to ten days.  It is usual to hear of sufferers experiencing some minor to severe, generally spasmodic  ‘nerve type’ pain following the surgery – in most cases this will ease relatively quickly.  However, some sufferers do not experience any pain whatsoever as the result of the operation.

Note: Not all MPM sufferers have fluid build up and require, or are suitable to have a pleurodesis.  Your specialist thoracic surgeon will be in the best situation to discuss this with you.

VIDEO COVERING MALIGNANT PLEURAL MESOTHELIOMA and APPLICABLE SURGERIES

Mesothelioma specialist surgeon, Joseph S. Friedberg, MD, Charles Reid Edwards Professor of Surgery at the University of Maryland (USA) School of Medicine, is a world-leading surgeon in performing pleurectomy/decortication, a procedure that removes the diseased pleura while sparing a patient’s lung.  In a video, Dr. Friedberg explains how surgery can be beneficial and explains intraoperative strategies to remove microscopic disease that can improve survival for patients with malignant pleural mesothelioma (MPM).  The video is very informative about Malignant Pleural Mesothelioma in general, about the Pleurodesis Talc operation and the two major forms of radical MPM surgery; Pleurectomy/Decortication and Extra Pleural Pneumonectomy.

Pleurectomy/Decortication [P/D]

The most common type of radical, or major surgery for pleural mesothelioma is a pleurectomy/decortication, where the lining (pleura) of the chest cavity and any tumour growth is removed – it may also involve removing a hemi-diaphragm and the pericardium.  It is often referred to as a lung-sparing operation or surgery.  The theory behind this operation is that it has a three fold  benefit; in that it not only removes the cancerous growth and tissue that may contain asbestos fibres, but also removes restrictive fibrous tissue and creates more room in the chest cavity, thus allowing the lung more freedom to expand.

There is no standard for this operation, it is very much up to the surgeon how aggressive, or how much tissue is removed.  A sufferer will normally be required to under go a number of tests, including high definition scans (normally a PET scan) to evaluate the spread of the disease, to determine whether or not the operation is suitable for the sufferer.  If the surgery is performed, it will normally be done in conjunction with standard treatment chemotherapy (either before or after the surgery – dependent on the surgeon) and possibly entail a regime of radiotherapy following the surgery.  As this is not a standard operation, you should ask and be made very aware of exactly what the surgeon is envisaging doing – in other words what will be removed!

Extra Pleural Pneumonectomy [EPP]

Less common surgery for pleural and/or pericardium mesothelioma is an extra pleural pneumonectomy. It is an extremely aggressive operation in which one lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.  Is is considered extremely radical surgery, and is only deemed suitable for a very small numbers of relative fit Malignant Pleural Mesothelioma (MPM) sufferers who can meet a demanding criteria.

Before a sufferer could be considered for this form of surgery, they will generally be required to under go a number of tests, including high definition scans (normally a PET scan) to evaluate the spread of the disease, and lung function and heart testing, as the rigors of this type of surgery places more pressure on the remaining lung and the function of the heart. Invariably, having this operation will mean a long period of recuperation.  As with a pleurectomy/decortication lung sparing operation, it will normally be done in conjunction with standard treatment chemotherapy (either before or after the surgery – dependent on the surgeon) and possibly entail a regime of radiotherapy following the surgery.

People who have undergone the operation, and have had good results, have reported up to a 12 month (or possibly longer) follow up treatment and recuperation period.  Due to the loss of one lung a patient should not expect to ever reach a full ‘pre-disease’ level of fitness.  This operation is only undertaken by a very small number of surgeons in Australia.

As with all Malignant Mesothelioma treatments there are no givens.  This operation is high risk surgery with no guarantee of survival or success, that being said there are those who have, or consider they have, benefited in terms of longevity and quality of life.  On the other hand there are those who did not survive the operation, or if they did, did not appear to have received any tangible benefits.  It is an operation that requires careful consideration.  Please read the downloadable and printable document ‘Questions to answer regarding Surgery‘ This document has been designed for you to print off and be able to write the answers in as you ask the surgeon.

If you are considering having an EPP operation, please contact the MS Jocelyn McLean MSM (Res), Mesothelioma Support Co-ordinator, the ADRI (Asbestos Diseases Research Institute) at the Bernie Banton Centre, to talk about it, and to request a soft copy of an Australian produced booklet specifically about the EPP operation.

Jocelyn can be contacted by:
Phone: +61 2 9767 9854
Toll Free: 1300 237 400 (within Australia)
Email: support@adri.org.au

Malignant Peritoneal Mesothelioma Surgery

Peritonectomy (also commonly referred to as Cytoreductive or Debulking) Surgery

Peritonectomy surgery is where cancerous sections of the lining of the abdominal cavity are removed in the hope of stopping the spread of disease and to relieve pressure being placed on vital organs.  Often other organs such as the stomach, spleen, gall bladder, and in women, the reproductive organs may have to be removed as well. 

Peritonectomy surgery is often performed in conjunction with HIPEC (see below), it is extremely aggressive surgery, with an operation normally taking between 8 and 12 hours.  It is normally followed up by a regime of chemotherapy, if the patient is well enough to undertake it. This surgery is only carried out by a very small number of surgeons in Australia.  It is generally regarded as palliative treatment, and may increase the life expectancy of sufferers.

Heated Intraperitoneal Chemotherapy [HIPEC]

Heated Intraperitoneal Chemotherapy is when  heated chemotherapy is infused into the open ‘peritoneal cavity’ (stomach) during the final stages of a Peritonectomy operation.

Why you should question the surgeon

Sufferers deemed suitable to have radical surgery operations are highly selected based on well-being and cancer progression. They must not only be deemed fit enough, but be a good candidate for long-term survival.  This generally is not the case for therapies and less radical surgeries.  As such it is easy to see the survival figures for the main radical surgery operations in comparison to other treatments may be artificially inflated.  Then there is the question of how well an individual sufferer would have gone on standard mesothelioma therapy treatments – some sufferers have outstanding results from therapy treatments, as do some from from radical surgery.  Be sure to question a surgeon who indicates surgery is the only hope of achieving longevity and quality of life for a mesothelioma sufferer – as this is not necessarily so.  It is important to compare ‘apples to apples’ – please ensure you read the ‘Questions To Answer Regarding Surgery‘ pdf document (below).

Questions To Ask The Surgeon and Find Answers To when Discussing Radical Surgery (of any kind)

Continue on to read studies and watch a video about MALIGNANT PLEURAL MESOTHELIOMA

ANALYTICAL STUDIES on SURVIVAL AFTER MALIGNANT MESOTHELIOMA SURGERY

[Study #1]    Review of Malignant Pleural Mesothelioma Survival After Talc Pleurodesis or Surgery

click on the image below to read the study report

[Study #2]   Factors Associated With Survival In A Large Series of Patients With Malignant Pleural Mesothelioma in New South Wales

click on the image below to read the study report

[Study #3]    Long-Term Survival Outcomes of Cancer-Directed Surgery for Malignant Pleural Mesothelioma

click on the image below to read the study abstract report

Points To Ponder (and further reasons why you should thoroughly question the surgeon):

• The authors in Study #1 point out that generally those having aggressive surgery (average age for P/D = 60.9 years, for EPP = 57.5 years) are younger and healthier to start of with than those having the Talc Pleurodesis (average age 67.6 years), and this fact could contribute to a bias in the survival times.
• Sufferers deemed suitable to have Extra Pleural Pneumonectomy [EPP] surgery are highly selected based on well-being and cancer stage. They must not only be deemed fit enough, but be a good candidate for long-term survival.  This generally is not the case for therapies and less radical surgeries.  As such it is easy to see the survival figures for the EPP operation in comparison to other treatments may be artificially inflated.  It is important to compare ‘apples to apples’ – please ensure you read ‘Questions To Answer Regarding Surgery‘ pdf document (above).
• Whilst those who underwent EPP surgery were judged to have lived for an average of 9.3 months longer (over the 3 studies) than those who didn’t have radical surgery – what amount of this extra 9.3 months (remember these are only statistics – everyone is an individual and will respond differently) was spent in hospital, recuperating, or spent having follow up treatment of some kind?  Literature suggests an average of 6 to 12 months, if the operation is successful.
• Although no specific age figures are readily evident in Study #2 and Study #3, it is generally younger, fitter patients who undergo EPP Trimodial Therapy, due to the aggressive nature of the surgery involved and extended period of recuperation.  Age figures in Study #1 (57.5 years) would seem to be indicative across most literature available for the average age of mesothelioma sufferers having the EPP surgery.  Whereas the average age of mesothelioma sufferers at diagnosis listed in Study #2 is 72 years of age.
• Due to the loss of one lung, sufferers who undergo an EPP operation can never expect to return to a full level of fitness, however, if the operation is successful, a sufferer can hope to achieve a quality of life for some period before the disease relapses – this will vary greatly from sufferer to sufferer.
• How do you equate and decide what is quality of life?  (This is a very individual thing – no one can answer this for you.)

Supportive Care Options

Supportive Care Options is about maintaining or improving quality of life for sufferers of asbestos or dust related disease, at the same time allowing their loved ones to also have a quality of life during all stages of the disease. It is about working out what support and care options are available, and then putting in place strategies to help sufferers and their loved ones navigate the journey ahead in the best possible way.

Supportive Care Options should be discussed as soon as possible after diagnosis with your treating physician, hospital social worker or other care providers.  You should also talk immediately with a specialist asbestos dust litigator regarding possible compensation.

Find Out More

To find out more to go to the Support & Care section of this website by clicking [here].

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