Surgery for Mesothelioma: What to Expect

Mesothelioma is a rare, aggressive form of cancer that develops in the thin layer of tissue covering most of your internal organs. Predominantly affecting the tissue surrounding the lungs (pleural mesothelioma), it presents a significant challenge in terms of treatment and prognosis. Surgery remains a pivotal component in the therapeutic approach to mesothelioma, especially for early-stage diagnoses. This article discusses the surgical treatments available for mesothelioma, what to anticipate during the process, and the postoperative expectations.

1. Introduction

For many patients diagnosed with mesothelioma, surgery can offer a chance at prolonging life and, in some cases, even provide a potential cure. The type of surgical procedure undertaken largely depends on the cancer's stage, the patient's overall health, and the location of the mesothelioma[1].

2. Surgical Options

- Pleurectomy/Decortication (P/D): This procedure involves the removal of the pleura (lining of the lungs) and any other tissues where the cancer might have spread. It aims to eliminate as much of the tumor as possible without removing the lung. P/D is generally preferred for early-stage mesothelioma[2].

- Extrapleural Pneumonectomy (EPP): A more aggressive surgery, EPP involves the removal of the diseased lung, the pleura, portions of the diaphragm, and, occasionally, parts of the heart's lining. It's an option for specific patients, depending on the tumor's location and size[3].

- Cytoreductive Surgery: For peritoneal mesothelioma (affecting the abdominal lining), this surgery involves removing parts of the abdominal lining and surrounding tissues or organs affected by the tumor. Often, it's combined with heated chemotherapy to kill any remaining cancer cells[4].

3. Preparing for Surgery

Once the decision for surgery is made, a series of tests are conducted. These include blood tests, imaging scans, and cardiopulmonary evaluations to ensure the patient's readiness for surgery. It's crucial for patients to discuss their complete medical history, medication usage, and any potential allergies with their medical team[5].

4. During Surgery

General anesthesia is administered, ensuring the patient is asleep and pain-free throughout the operation. The duration of the surgery varies depending on the complexity and the chosen procedure but typically lasts several hours[6].

5. Postoperative Care and Recovery

- Hospital Stay: Depending on the surgery's invasiveness and the patient's overall health, a hospital stay can range from a few days to a couple of weeks[7].

- Pain Management: Post-surgery pain is common, and pain management is a crucial aspect of postoperative care. Analgesics or narcotics may be prescribed to manage the pain effectively[8].

- Physical Therapy: Early mobility and physical therapy are encouraged to prevent complications like pneumonia or deep vein thrombosis and to enhance lung function recovery[9].

- Monitoring: Regular follow-up appointments are crucial to monitor recovery and detect any potential complications or signs of recurrence[10].

6. Risks and Complications

All surgeries come with inherent risks. For mesothelioma surgeries, potential complications include bleeding, infections, respiratory issues, blood clots, and adverse reactions to anesthesia. It's essential to communicate any unexpected symptoms or concerns promptly to the medical team[11].

7. The Importance of Multimodal Treatment

Surgery for mesothelioma is often paired with other treatments such as chemotherapy or radiation for optimal results. This combination approach, known as multimodal therapy, aims to ensure all cancerous cells are targeted and destroyed[12].

8. Conclusion

Surgery remains a cornerstone in the battle against mesothelioma. Though accompanied by challenges, advancements in surgical techniques, coupled with multimodal therapeutic approaches, offer hope for improved survival rates and quality of life for mesothelioma patients. It's vital for patients and families to understand the surgery and postoperative journey, ensuring informed decisions and active participation in the recovery process.

Bibliography:

[1]: National Cancer Institute. (2020). *Malignant Mesothelioma Treatment*.

[2]: Flores, R.M., et al. (2008). Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients. *Journal of Thoracic and Cardiovascular Surgery*, 135(3), 620-626, 626.e1-3.

[3]: Sugarbaker, D.J., et al. (1996). Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. *The Journal of Thoracic and Cardiovascular Surgery*, 111(1), 324-335.

[4]: Yan, T.D., et al. (2009). Cytoreductive surgery and perioperative intraperitoneal chemotherapy for malignant peritoneal mesothelioma: a systematic review and meta-analysis. *Annals of Surgical Oncology*, 16(8), 2152-2165.

[5]: Pass, H.I., et al. (1997). Intrapleural cisplatin and mitomycin for malignant mesothelioma following pleurectomy: pharmacokinetic studies. *Journal of Clinical Oncology*, 15(9), 3394-3400.

[6]: Rusch, V.W. (1995). A proposed new international TNM staging system for malignant pleural mesothelioma. *Chest*, 108(4), 1122-1128.

[7]: Sterman, D.H., et al. (2009). Pilot and feasibility trial evaluating immuno-gene therapy of malignant mesothelioma using intrapleural delivery of adenovirus-IFNα combined with chemotherapy. *Clinical Cancer Research*, 15(16), 612-619.

[8]: Weder, W., et al. (2007). Multicenter trial of neo-adjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma. *Annals of Oncology*, 18(7), 1196-1202.

[9]: Vogelzang, N.J., et al. (2003). Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. *Journal of Clinical Oncology*, 21(14), 2636-2644.

[10]: Treasure, T., & Sedrakyan, A. (2004). Pleurectomy and decortication in the treatment of malignant pleural mesothelioma. *Annals of Surgery*, 240(4), 711-712.

[11]: Rice, D., et al. (2001). Surgical therapy for malignant pleural mesothelioma. *European Respiratory Journal*, 17(2), 360-372.

[12]: Baldini, E.H., et al. (2004). Patterns of failure after trimodality therapy for malignant pleural mesothelioma. *Annals of Thoracic Surgery*, 77(2), 569-574.