Surgery
Surgery involves removing tissues or organs from the body. The type of surgery you have depends on your cancer. You may also hear surgery called an operation or a procedure.
Every operation is different. Ask your surgeon about what to expect.
What you need to know
Surgery for pleural mesothelioma
Surgery to control mesothelioma and manage symptoms
Most people with pleural mesothelioma are diagnosed when the disease is advanced and are not suitable for radical surgery. They may still benefit from surgery to relieve symptoms caused by the disease.
One of the main problems caused by pleural mesothelioma is a build-up of fluid in the pleural cavity (the space around the lung between the pleural membranes). This is known as a pleural effusion. It puts pressure on the lung and makes it difficult for the person to breathe.
Procedures which can help to relieve symptoms include:
- pleurodesis – fluid is drained from the pleural cavity under a general anaesthetic using video assisted thoracoscopy. Talc or other substances are then used to make the layers of the pleura stick together and reduce the build-up of fluid between them.
- partial pleurectomy – at the same time as a pleurodesis, the surgeon removes part of the affected pleura and as much of the mesothelioma as possible. This is to control growth of the mesothelioma and reduce fluid build-up, allowing the lung to expand and make breathing easier.
- thoracentesis or pleural tap – fluid is removed from the pleural cavity using a needle. In some cases, a catheter or tube, known as an indwelling pleural drain, is left in place. This allows fluid to be drained as it builds up.
Potentially curative surgery
A very small number of people may be suitable for surgery intended to remove all the mesothelioma and prevent it returning. These people have early stage disease and a slow-growing type of mesothelioma. They also need to be healthy enough to cope with major surgery.
Types of surgery that may be considered include:
- pleurectomy and decortication – radical removal of the mesothelioma and the pleura from that side of the chest leaving the lung intact.
- extrapleural pneumonectomy (EPP) – radical surgery to remove all of the pleura, the lung, diaphragm and part of the heart covering (pericardium) on the affected side of the chest.
People who have these types of surgery generally have chemotherapy before surgery and radiation therapy after surgery to reduce the chance of the mesothelioma coming back. This is known as trimodality therapy.
Clinical follow-up and rehabilitation is important after radical surgery to help patients make the best recovery possible.
Surgery for peritoneal mesothelioma
Surgery to control the mesothelioma or manage symptoms
Most people have advanced disease when they are diagnosed with peritoneal mesothelioma. They may still be able to have some surgery or procedures to control the growth of the mesothelioma and reduce symptoms.
One of the main problems caused by peritoneal mesothelioma is a build-up of fluid in the abdominal cavity. This is known as ascites.
Procedures which can help to relieve ascites symptoms include:
- paracentesis or peritoneal tap – removal of the fluid from the abdominal cavity using a needle – in some cases a catheter or tube is left in place to drain the fluid.
- a single dose of hyperthermic intraperitoneal chemotherapy (HIPEC) – heated chemotherapy is given into the abdomen during a laparoscopy.
Surgery for early peritoneal mesothelioma
A small number of people with peritoneal mesothelioma may be able to have an operation called a peritonectomy.
The mesothelioma needs to be slow-growing and localised to the area where it started, and the person needs to be fit enough for the surgery.
Peritonectomy is radical surgery, which is only performed at a small number of specialist centres. It is also known as cytoreduction or debulking surgery. It involves removing as much of the peritoneum as possible, together with any visible mesothelioma in the abdominal cavity. This may include removing parts of some abdominal organs.
Peritonectomy often includes the use of hyperthermic intraperitoneal chemotherapy (HIPEC). This is when heated chemotherapy is given into the abdomen to kill cancer cells left behind after the surgery.
The surgical team
Health professionals who work as part of the surgical team include:
- surgeon
- anaesthetist
- nurse
- allied health professional.
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What to ask or talk about
Side effects of surgery
Possible general surgical side effects and complications include:
- pain
- infection
- bleeding
- lymphodema
- tiredness
- loss of appetite
- blood clots.
Possible side effects from pleural mesothelioma surgery include:
- changes in heart rhythm
- pneumonia
- loss of lung function.
Possible side effects from peritoneal mesothelioma surgery include:
- fistula
- abscess
- sepsis.
Your surgeon will discuss any risks of the surgery with you before your operation. Most hospitals will also give you written information about the surgery and who to contact if you have any concerns.
The surgical team looking after you during and after your operation will take care to reduce your risk of side effects, and treat any that you get.
Checklists
Next steps
Preparing for surgery
Before surgery, you will need to sign a consent form. It is important you understand what you are consenting to and the possible risks of the surgery.
Some things you should know are:
- whether you need to have tests and a preoperative assessment
- whether you need to change or stop any medications, e.g. blood thinners like aspirin
- when you have to stop eating and drinking
- when you have to be there
- whether you need time off work
- whether you need someone to care for you at home after surgery (if you are having day surgery you will need someone to drive you home).
