Surgery for Malignant Mesothelioma

People with malignant pleural mesothelioma or peritoneal mesothelioma who can’t tolerate major surgery may be good candidates for a minimally invasive procedure. A catheter called PleurX^® drains excess fluid that accumulates in the chest or abdomen as a result of the cancer.

During a minor surgical procedure, your doctor implants a permanent catheter—a thin, flexible tube—in your chest or abdomen. Most of the catheter remains hidden, except for a small valve on the outside of the body. To drain fluids, you attach the valve to a bottle with a small vacuum in it.

Once attached, the fluid from your chest or abdomen is sucked out through the internal catheter and into the bottle. Your doctor can show you how to drain the catheter at home. Draining takes about 15 minutes and is done once every one or two days.

Another fluid-draining approach used for people who can’t tolerate major surgery is pleurodesis. In this procedure, doctors make an incision in the chest and insert a thoracoscope, a lighted tube, to remove fluid from the cavity. They replace it with a material—either talc or chemotherapy drugs—that adheres to the chest wall and inflames the lining, preventing fluid from accumulating.

Pleurodesis requires general anesthesia. You may need to stay in the hospital overnight so our doctors can monitor you and manage any discomfort.

Pleurectomy decortication surgery is an aggressive approach reserved for people in the earliest stages of malignant pleural mesothelioma. Only 20 to 30 percent of people with this form of cancer qualify for the procedure.

Using general anesthesia, your surgeon removes the lining of the chest wall on the side where the cancer is, along with the lining of the lung. This releases the part of the lung that’s been limited, or trapped, by the cancer.

The goal is to remove as much of the cancer as possible. The benefit of this procedure is the lung can often be spared. Recovery time in the hospital may be a week to 10 days, during which you receive any needed rehabilitation.

Doctors may recommend an extrapleural pneumonectomy for people who have early malignant pleural mesothelioma that has not spread to other parts of the body. This aggressive treatment approach involves removing a lung and parts of the chest lining, heart lining, lymph nodes, and diaphragm.

Using general anesthesia, your surgeon makes an incision in the front or side of the body near the rib cage. He or she removes as much of the cancer as possible. People who have this procedure usually receive chemotherapy before surgery. However, with very early mesothelioma, the chemotherapy is delivered after the surgery. This may help prevent the condition from returning in other parts of the body.

After the procedure, you may remain in the hospital for at least one week. During this time, you can start physical and pulmonary rehabilitation to help with breathing. You may also require several months of outpatient rehabilitation.

Surgeons may use an approach called cytoreduction, in addition to hyperthermic intraperitoneal chemotherapy, to treat peritoneal mesothelioma.

In cytoreduction, the doctor makes an incision in the abdomen and carefully examines the peritoneum and the structures and organs that it surrounds, including the abdominal cavity and the stomach, spleen, kidneys, liver, intestines, pancreas, and gallbladder. Surgeons then remove as much of the mesothelioma as possible. Hyperthermic intraperitoneal chemotherapy immediately follows to help destroy any microscopic cancer cells.

This procedure can take several hours and requires general anesthesia.

Sometimes surgery for mesothelioma may cause breathing problems because lung tissue is removed. It can also cause weakness, as well as difficulty with walking and performing your normal daily activities. You may be a candidate for the inpatient pulmonary rehabilitation program at Rusk Rehabilitation if you are not ready to go home after surgery.

After you return home, the doctors at Rusk Rehabilitation’s outpatient pulmonary rehabilitation program can give you exercises to help improve your breathing, strength, and physical function so you can continue to participate comfortably in your normal daily activities.