There are a number of surgical procedures that will be performed by a medical team after the stage of your mesothelioma has been determined.
Some diagnostic surgeries that may be performed in order to determine your diagnosis as well as your stage are:
Thoracoscopy: A thoracoscopy uses an endoscope to visually examine the pleura, lungs, and mediastinum and to obtain tissue for testing purposes. An endoscope is an illuminated optic instrument that is inserted through an incision. Chemical pleurodesis, a procedure whose goal is to elleviate some of the fluid accumulation in the intrapleural space may also be performed during the thoracoscopy. This procedure is less invasive than a biopsy but can only be performed when the tumor has not obliterated the pleural space.
VATS, or video-assisted thoracic surgery: Video-assisted thoracic surgery (VATS) is a recently developed type of surgery that enables doctors to view the inside of the chest cavity after making only very small incisions, and collect tissue samples which can further be examined by a pathologist. It allows surgeons to remove masses close to the outside edges of the lung and to test them for cancer using a much smaller surgery than doctors needed to use in the past. It is also useful for diagnosing certain pneumonia infections, diagnosing infections or tumors of the chest wall, and treating repeatedly collapsing lungs. The extent of the tumor, pleural involvement, chest wall invasion may be determined using this procedure.
Mediastinoscopy: This is a procedure which may be performed in order to determine the extent of the disease. Patients are given general anesthesia and an endotracheal tube is placed in the patient’s nose or mouth to assist the patient in breathing. A small surgical cut is made in the neck and a device called a mediastinoscope is inserted through this incision into the mid-part of the chest. Tissue samples are taken of the lymph nodes around the airways. The scope is then removed and the surgical cut is closed with stitches.
Laproscopy: Laparoscopy allows the medical team to directly view the peritoneal cavity, ovaries, outside of the tubes and uterus by using a laparoscopy. The laparoscopy is an instrument somewhat like a miniature telescope with a fiber optic system which brings light into the abdomen. It is about as big around as a fountain pen and twice as long. Carbon dioxide (CO2) is put into the abdomen through a special needle that is inserted just below the navel. This gas helps to separate the organs inside the abdominal cavity, making it easier for the physician to see the organs. The gas is removed at the end of the procedure.
Microlaparoscopy a new minimally invasive diagnostic surgical procedure uses telescopes and instruments that are much smaller than normal. If this procedure is appropriate for your condition, smaller incisions will be made and postoperative abdominal tenderness may be reduced.
Palliative surgical procedures may be performed in order to alleviate some of the more severe symptoms associated with mesothelioma, but is not used to treat the disease itself. Some of these procedures are:
Pleurodesis: Pleurodesis is a procedure that causes the membranes around the lung to stick together and prevents the buildup of fluid in the space between the membranes. This procedure is done in cases of severe recurrent pleural effusion (fluid around the lungs), as from cancer, to prevent the reaccumulation of fluid. In pleurodesis, an irritant (such as Bleomycin, Tetracycline, or talc powder) is instilled inside the space between the pleura (the two layers of tissue lining the lungs) in order to create inflammation which tacks the two pleura together. This procedure thereby obliterates the space between the pleura and prevents the reaccumulation of fluid.
Pleuroperitoneal Shunt: During the pleuroperitoneal shunting procedure a catheter is tunneled subcutaneously towards peritoneal cavity through the pleural space. The pleural fluid is drained out of the affected hemithorax using a manual pump and one-way valve. This procedure produces relief if there exists a malignant effusion recurrence. Patients suffering recurrent, symptomatic pleural effusions within the area of a tapped lung can may consider outpatient external fluid drainage through a semipermanent intrapleural catheter as a palliative treatment.
Pleurectomy: A pleurectomy may be used as a palliative procedure. It is considered the most effective means of controlling pleural effusion in cases where the lung’s expansion is restricted by disease.
Surgical procedures may also be performed in a small number of cases in which the mesothelioma has been detected early and the patient does not have any underlying medical conditions. The goal of these procedures may be to alleviate a portion of the more severe symptoms or to remove the diseases.
For Pleural Mesothelioma:
* Pleurectomy: During a pleurectomy, a surgical team removes the parietal pleura and visceral pleura, and may or may not include the removal of a portion of the pericardial or a portion of the diaphragm. The lung is left behind. The pleural space around it is sealed and resectioned so that no further fluid can collect there.
* Extrapleural Pneumonectomy: This procedure is considered to be more radical than other surgical approaches and is usually only performed in severe cases. During a pneumonectomy the entire lung is removed along with the extrapleural, meaning that the parietal and viscera pleura, a portion of the diaphragm, a portion of the covering of the heart (pericardium) are removed as well on the side affected by mesothelioma. The extrapleural pneumonectomy is performed under general anesthesia with double-lumen endotracheal intubation.
