Surgery for Peritoneal Mesothelioma

Treatment for peritoneal mesothelioma may include a multimodal treatment method since surgery and intraperitoneal chemotherapy alone have not proven to be effective. Cytoreductive surgery is the method used. Cytoreductive surgery is a debulking involving the removal of all or most visible tumors combined with intra-peritoneal hyperthermic chemotherapy (PHC), intraperitoneal chemotherapy and or radiation. Since there is always a chance of not being able to remove all tumors, the long-term prognosis for survival is based on the effectiveness of the particular cytoreduction surgery. The criteria established for complete and incomplete cytoreduction surgery are as follows: Complete Cytoreduction SurgeryCC-0 - no peritoneal seeding is visible within the operative fieldsCC-1- nodules less than 2.5 cm remains following cytoreduction. Though nodules exist, the cytoreduction is still considered to be complete since the remaining nodules are of a size that is expected to be penetrated by intracavitary chemotherapy. 

Incomplete Cytoreduction Surgery

CC-2 - nodules between 2.5 cm and 5 cm remain following cytoreduction.CC-4 - nodules greater than 5 cm or a merging of any unresectable nodules anywhere within the abdomen or pelvis remain following cytoreduction. 

Surgery for Pleural Mesothelioma

Pleural mesothelioma is an aggressive cancer that is more difficult to treat than peritoneal mesothelioma. Many treatment options exist for pleural mesothelioma. The appropriate treatment option for any particular patient is dependent upon a number of factors. Surgery, chemotherapy, radiation therapy or a trifocal combination of the three may be sought as well as the participation in clinical trials, gene therapy and a number of other options. After a proper diagnosis is completed, the available options should be discussed with a doctor since new and more effective treatment methods continue to evolve.

Surgery for pleural mesothelioma may be performed to either relieve the pain and discomfort or to cure the cancer. When surgery is performed to relieve pain and discomfort, it is described as palliative surgery. Palliative surgery is usually performed when the patient is too ill or weak to sustain more extensive surgery or the cancer has spread beyond the mesothelium to other parts of the body and the cancer is difficult to completely remove. A procedure known as pleurectomy /decertification provides for the pleura to be removed. This procedure has been shown to be effective in controlling fluid build-up, improving breathing and reducing pain.

Curative surgery is generally reserved for those patients who are otherwise in good health, have a cancer tumor that is believed to be localized and completely removable. Though procedures are designated as curative, cancer has a tendency to spread to areas where doctors are not able to detect it. When cancer spreads into walls of the chest, over nerves, around the heart or over the diaphragm, doctors may not be able to detect the cancer prior to surgery. In this case, the surgery is not really curative, but life extending. Some patients who have been in this situation have experienced long periods of remission. A procedure known as extrapleural pneumonectomy provides for the pleura lining the walls of the chest, diaphragm and pericardium to be removed along with the entire lung on the side of the tumor. A prosthetic material is then used to reconstruct the diaphragm and pericardium. The surgical procedure is an attempt to remove all or most of the cancer as well as some of the surrounding tissues. Only surgeons in specialized medical facilities are qualified to perform this type of complex operation.

Surgery for Other Types of Mesothelioma

Mesotheliomas of the pericardium and vaginalis testis are the most rare forms of mesothelioma. Surgery has been effective in removing cancer if it is detected in the very early stages, but the medical community has not established a best method for treating later stages of these forms of mesothelioma. Surgical treatment for peritoneal mesothelioma is similar to those methods specified above for pleural mesothelioma. Surgery is performed to remove cancer cells from the pericardium membrane that surrounds the heart. Surgery for vaginalis testis is usually not curative since it is not likely that the cancer will be completely removed. In many instances of vaginalis testis, a tumor is confused with a hernia and doctors are not able to differentiate the tumor from a hernia until after the surgery has begun.