Mesothelioma surgery is a common treatment option that can be used during the diagnostic process to retrieve a biopsy specimen. To remove cancer as short-lived as possible or to palliatively reduce the patient's symptoms. Surgery is often part of a multimodal plan that is used in combination with chemotherapy and/or radiotherapy.
There are many types of mesothelioma operations, which vary according to the purpose and location of the mesothelioma. Aggressive surgery is most common in early-stage patients with minimal variability and is often not an option for advanced patients, elderly patients or those with poor general health. Die Operation by Mesothelioma Kann Pleurectomy / Decortication (P / D) and extrapleural Pneumonectomy (EPP) umfassen. P / D entfernt allies erkrankte Gewebe um die Lunge, während EPP much die Lunge entfernt. Die Patienten müssen sich in einem gesunden Gesundheitszustand befinden und eine begrenzte Verbreitung von Krebs haben, um von einer größeren Operation zuprofitieren.
How surgery treats mesothelioma
Surgery is a primarily a conventional treatment for mesothelioma, but can also be used prior to treatment during diagnosis. Early detection is the best way to improve the patient's prognosis. Surgical biopsies allow doctors to collect tissue or fluid samples for analysis to confirm malignancy, type of cancer, cell type, and staging.
Mesothelioma healing procedures aim to remove cancer as much as possible, including mesothelioma tumors and, if possible, affected organs or tissues. This option is most common for patients with stage 1 or stage 2 mesothelioma when mesothelioma tumors are still localized.
During stages 3 and 4, cancer has spread to distant lymph nodes or organs, and patients overall may be in poor health, thereby precluding surgery as a possible option. However, in patients with any stage of the disease, the surgery may be used palliatively to relieve symptoms and improve quality of life. Common symptoms of malignant mesothelioma include chest pain or abdominal pain, shortness of breath and shortness of breath caused by fluid accumulation (peritoneal and pleural effusion). Palliative surgery is common in reducing tumor size and draining excess fluid, reducing pressure, and providing symptomatic relief.
What is the best treatment for mesothelioma?
Major surgery is considered the best treatment for mesothelioma because it offers the greatest chance of survival. If an experienced surgeon can remove any visible signs of cancer before it spreads, you could live many years after surgery.
Before you talk about surgery as an option, physicians should make sure that your body is strong enough to tolerate and recover from major surgery. They determine lung and heart health by performing a pulmonary function test and performing cardiac tests. These tests may include an electrocardiogram (ECG), a stress test, an echocardiogram or a coronary angiogram.
If your overall health is strong enough to withstand possible surgery complications and your mesothelioma has not spread too much, your doctor will approve you as a candidate for surgery. The operation involves risks, but the potential rewards are great. Many of the survivors at our Wall of Hope opted for surgeries that gave them more years for children and grandchildren.
Types of Mesothelioma Surgery
Operations vary depending on whether they serve diagnostic, curative or palliative purposes, as well as their location, which is determined by the type of mesothelioma. Diagnostic operations are used to collect a sample to accurately diagnose the disease, while curative operations are treatments that seek to remove as much cancer as possible. Palliative surgery is supposed to relieve the symptoms for the patient.
Diagnostic Mesothelioma Surgery
The biopsy is the only definitive way to diagnose mesothelioma and can be done by taking a sample of fluid or tissue. Surgical biopsy specimens may be minimally invasive, although some are considered open surgical procedures, as the affected tissue or fluid may be more difficult to reach or to ensure the removal of a sufficiently large specimen for proper analysis.
Thoracoscopy: A minimally invasive biopsy to diagnose pleural mesothelioma. Small incisions are made between the breast and ribs to remove a tissue sample from the pleura or thoracic cavity.
Laparoscopy: A minimally invasive biopsy most often used to diagnose peritoneal mesothelioma. In abdominal and abdominal incisions are made while gas inflates the abdominal cavity. An area is then used to locate and remove a tissue sample.
Mediastinoscopy: A minimally invasive biopsy used to diagnose pericardial mesothelioma or suspected breast metastasis.
Thoracotomy: An open surgical procedure for the diagnosis of pleural and pericardial mesothelioma, where a cut is made in the chest wall to collect a tissue sample around the heart, lungs, or other areas where tumors are believed to grow.
Laparoscopy: An open surgical procedure to diagnose peritoneal mesothelioma, using a mediastinoscope below the neck to locate and extract a tissue sample for analysis.
Pleural Mesothelioma Surgery
The surgical treatment of the pleural mesothelioma has improved since it began in the 1970s. However, the rarity of this cancer means that most patients still have to travel to a specialist cancer center to visit a mesothelioma specialist.
Diagnosis of pleural mesothelioma and relief of symptoms
The primary diagnostic procedure for pleural mesothelioma is a thoracoscopy. For diagnosis, the two main palliative procedures thoracocentesis and pleurodesis can also be used.
Thoracoscopy
Thoracoscopy is also referred to as video-assisted thoracoscopic surgery (VATS). This procedure involves inserting a special camera and a long, thin probe through small incisions in the chest area. These tools allow a physician to take a biopsy sample from the lung tissue without having to open the entire chest cavity.
Thoracentesis
If fluid forms between the two layers of the pleural lining surrounding the lung, a doctor may drain it through a hollow needle. This procedure relieves pressure and makes breathing easier. The pleural mesothelioma fluid can then be tested for cancer cells as part of the diagnostic process.
Pleurodesis
In this method, as in a thoracocentesis fluid collections are drained. It then goes one step further by sealing the area to prevent the formation of liquid again in the future. Doctors typically inject talc into the pleural cavity to seal it, though chemicals may be used in certain cases.
Removal of pleural mesothelioma tumors
Doctors primarily use two different tumor treatments for the pleural mesothelioma: extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P / D). About 15 to 20 percent of people with pleural mesothelioma qualify for a tumor-removing surgery.
The "Thoracotomy" is a general term for an operation that allows physicians access to a patient's lungs, heart, aorta, trachea, or diaphragm. For this purpose, a 4 to 10-inch long cut must be made on each side of the chest. Extensive procedures such as EPP and P / D require a thoracotomy. A thoracotomy is also the first step in several asbestos-related lung cancer operations. These operations include pneumonectomy, lobectomy, wedge resection, and segmentectomy.
Unfortunately, up to 25 percent of mesothelioma patients released for surgery are inoperable after thoracotomy. Doctors are trying to predict this with the latest advances in imaging technology and other diagnostic techniques. Surgeons, however, can not determine whether a planned tumor removal operation is actually possible until they look into the patient.
In cases where cancer has spread too far to operate, surgeons will pinpoint the cancerous stage. This can determine the overall treatment plan of the patient. If the cancer is localized, surgeons will proceed to remove the tumor.
Peritoneal Mesothelioma Surgery
Peritoneal mesothelioma accounts for less than the quarter of all mesothelioma cases. It is an unusual variant of cancer that is rare anyway. Untreated, it is also more aggressive than other types of mesothelioma. Not so long ago, almost everyone who was diagnosed with peritoneal mesothelioma survived on average only six months.
However, peritoneal mesothelioma patients today benefit from one of the greatest advances in mesothelioma treatment: the HIPEC procedure. Almost half of the peritoneal patients treated with this particular combination of surgery and chemotherapy live for over five years.
Diagnosis of peritoneal mesothelioma and relief of symptoms
Paracentesis is a minor surgical procedure that may serve diagnostic or palliative purposes. Cancer can cause fluid to accumulate in the peritoneal cavity, the space between the two membranes that separates the abdominal organs from the abdominal wall. Doctors can drain the fluid through a hollow needle to relieve the nearby organs. Peritoneal fluid accumulation is also referred to as ascites, and this procedure is sometimes called an abdominal or ascites stroke.
Doctors can examine ascitic fluid to confirm the diagnosis of peritoneal mesothelioma. Ascites, also known as peritoneal effusion, are common in peritoneal mesothelioma. Repeated therapeutic paracentesis procedures may be administered as a palliative treatment for patients with advanced stages of this disease.
Removal of peritoneal mesothelioma tumors
Almost 40 percent of peritoneal mesothelioma patients are qualified for the removal of tumors. The most effective treatment for this disease combines peritonectomy with a HIPEC procedure.
Peritonectomy
In this procedure, the surgeons remove the diseased parts of the peritoneal lining. Subsequently, they perform a cytoreductive surgery to remove as much as possible cancerous growth from the abdominal cavity. This is also called debulking surgery and may involve the removal of parts of the liver, pancreas, spleen, gallbladder, intestine, and stomach.
HIPEC treatment
Hyperthermic intraperitoneal chemotherapy (HIPEC) is given immediately after the debulking phase of peritonectomy. Mesothelioma specialists pump a heated mixture of chemotherapeutic agents directly into the abdominal cavity. They leave it there for up to two hours so it can be taken up by remaining cancer cells.
HIPEC has fewer side effects than oral or intravenous chemotherapy as the drugs are not injected directly into the bloodstream. This targeted chemotherapy allows physicians to use much stronger anti-cancer drugs. Part of the chemotherapy used is absorbed into the bloodstream. However, this causes less serious side effects than intravenous chemotherapy.
Pericardial Mesothelioma Surgery
Pericardial mesothelioma patients may experience chest pain, dyspnoea, and coughing. These symptoms are due to an accumulation of fluid in the heart lining. Pericardiocentesis can effectively remove fluid retention to relieve these symptoms.
Unfortunately, pericardial fluid rarely contains malignant cells when mesothelioma occurs. This procedure is ineffective for the diagnosis.
The tumor removal operation available for pericardial mesothelioma is a pericardiectomy. This surgery removes as much cancerous tissue as possible from the heart's lining. It can alleviate symptoms caused by pericarditis (inflammation of the pericardium) and pericardial effusion (accumulation of fluid in the pericardium). It is important to treat these conditions early before they cause fatal complications.
Cardiac surgeons also called cardiac surgeons, perform pericardectomy. Patients should ask themselves how many of these procedures a surgeon performed to assess the level of experience of the physician.
In some hospitals, more operations are performed than in others. For example, Cleveland Clinic surgeons follow Dr. Allan Klein, director of the hospital center for diagnosis and treatment of pericardial diseases.
Curative Mesothelioma Surgery
Curative mesothelioma surgery is typically used only in Stage 1 or 2 patients if the disease is not metastasized to distant lymph nodes or organs with the aim of removing cancer as much as possible. According to recent studies, only one in five patients with malignant pleural mesothelioma that has spread is undergoing surgical resection.
Researchers continue to search for the most effective methods of surgical treatment of mesotheliomas. Studies combined with radiotherapy and chemotherapy have resulted in improved survival rates as part of a multimodal treatment plan. Curative operations are often followed by radiotherapy or chemotherapy to kill remaining cancer cells and prevent recurrence, which is common in mesothelioma tumors. For example, studies have found that pneumonectomy followed by irradiation in 80-85% of patients can prevent recurrence of the tumor in the chest cavity.
Healing operations vary according to the type of mesothelioma and target the breast, abdomen or testicles. Usual curative operations by type are:
Pleural mesothelioma: pleurectomy, pneumonectomy, and extrapleural pneumonectomy
Peritoneal mesothelioma: peritonectomy and cytoreduction / debulking
Pericardial mesothelioma: pericardiectomy
Testicular mesothelioma: inguinal cortex and lymphadenectomy
Pleurectomy
Mesothelioma pleurectomy is a surgical procedure that removes the mesothelial lining of the lung and chest cavity and removes the pericardium (lining of the heart) and the peritoneum (lining of the abdominal cavity). In the case of pleurectomy/decortication, surgeons remove as much malignant tissue around the lungs as possible. In addition to the treatment of mesothelioma, this surgery can also be used to remove excess fluid from the lungs.
Pneumonectomy
If mesothelioma cancer is localized in a lung, pneumonectomy may be performed to remove the entire lung. If the patient has only one lung, it may affect breathing so not all patients may be able to undergo aggressive surgery.
Extrapleural Pneumonectomy
Extrapleural pneumonectomy (EPP) is an aggressive surgical procedure in which a lung and tissues surrounding the lungs are removed, e.g. As the linings of the heart and the abdomen and parts of the diaphragm or the entire diaphragm. As a rule, only patients who are at an earlier stage of diagnosis and in good health may undergo surgery because of the risks.
Peritonectomy
Peritonectomy is used to treat peritoneal mesothelioma by abdominal removal. Studies have shown success in combining peritonectomy with hyperthermic intraperitoneal chemotherapy (HIPEC) and prolonging life expectancy.
Cytoreduction / Debulking
The peritoneal mesothelioma can easily spread to the organs throughout the abdomen. In this case, a cytoreduction/induction can be used. This surgical procedure removes as many visible tumors as possible from the abdominal region and is often accompanied by HIPEC washing to kill remaining cancer cells and prevent recurrence.
Perikardiektomie
A pericardiectomy is used to treat pericardial mesotheliomas by removing the pericardium or the lining of the heart. In most cases, the pericardium is replaced with surgical Gore-Tex so that the heart can continue to pump.
Inguinal Orchiectomy
A groin orchiectomy is used to treat testicular mesothelioma by removing one or both testicles and the entire spermatic cord. Frequently, surgery is followed by chemotherapy or radiotherapy to kill remaining cancer cells and prevent metastasis or recurrence.
Lymphadenectomy
Lymphadenectomy typically follows an orchiectomy in the treatment of testicular mesothelioma when cancer has spread to the lymph nodes. This surgical procedure removes affected lymph nodes and allows specialists to further analyze cancer cells.
Palliative Mesothelioma Surgery
Mesothelioma surgery can also be done as a palliative treatment. Palliative surgery is most commonly performed on Stage 3 or 4 patients when surgical resection is no longer possible and the goal is to reduce symptoms and improve quality of life. Palliative mesothelioma operations by type include:
Pleural mesothelioma: pleuralenceesis and pleurodesis
Peritoneal mesothelioma: paracentesis
Pericardial mesothelioma: pericardiocentesis
Testicular Mesothelioma: Hydrocelectomy
Pleurozentese
A common symptom of malignant pleural mesothelioma is pleural effusion, in which fluid accumulates around the lungs and causes a range of other symptoms, such as shortness of breath, cough, and chest pain. Pleuralenthesis is a procedure in which this fluid is drained with a needle, which improves the comfort of the patient.
Pleurodesis
Similar to pleurectomy, pleurodesis is a pleural mesothelioma operation used to treat pleural effusion. A chemical substance such as talcum is used to irritate and inflame the pleural membranes, causing them to expand and adhere to each other where pleural fluid would otherwise accumulate. This allows the lungs to fully expand, reduce pain and improve breathing.
Paracentesis
Peritoneal fluid or fluid around the abdomen is a common symptom of peritoneal mesothelioma, which can then cause other symptoms such as abdominal swelling and pain, vomiting, loss of appetite, and nausea. Paracentesis is a procedure that drains excess fluid and relieves the patient's symptoms.
Pericardiocentesis
Pericardial mesothelioma can cause pericardial effusion or accumulation of fluid around the heart, resulting in chest pain, arrhythmia, and blood pressure changes. Pericardiocentesis is a surgical procedure in which excess fluid is drained from the pericardial space to reduce symptoms.
Hydrocelectomy
Testicular mesothelioma patients often have an unpleasant swelling of the scrotum. The hydrocele is a fluid-filled sac in the scrotum that causes swelling. Frequently performed during an orchiectomy, a hydrocelectomy removes the hydrele to reduce the swelling and associated symptoms.
Side effects of mesothelioma surgery
Side effects for mesothelioma patients undergoing surgery vary by type of surgery, type of mesothelioma, and patient characteristics such as general health, age, and other conditions. However, there are common side effects with surgery that patients can discuss with their medical team prior to treatment to fully understand the benefits and risks.
Common side effects of mesothelioma surgery
- Anesthesia complications
- Bleeding and blood clots
- Fatigue
- Heart complications
- Infection
- Loss of appetite
- Low blood pressure
- Deafness
- Pain
- Breathing problems
Depending on the invasiveness of the surgery, patients may need to be rescued at the hospital to monitor possible complications. There are often medications and other treatment options that patients can track to alleviate and prevent the symptoms of surgery. Researchers and thoracic surgeons continue to investigate the use of surgical intervention in mesothelioma treatment. In clinical trials, efficacy is measured by other treatment options.
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