Your doctor may recommend surgery to remove all tumor tissue visible to the naked eye. The surgical procedure will be the main contributor to the extension of life. The best candidates for a surgical procedure are those who have been diagnosed in earlier stages of disease, meaning that the tumor is still localized. However, even patients in more advanced stages of mesothelioma may sometimes be considered for surgery depending on their specific disease characteristic’s and response to pre-operative chemotherapy.
There are two major types of surgeries that may be performed:
Pleurectomy / Decortication. This surgery involves the removal of the lining of the chest wall and lung. Below is an illustration of a tumor in the parietal pleura (lining of the chest wall). This illustration also shows how this tumor is removed. The procedure is performed under general anesthesia. As shown, a blunt tool is guided between the tumor and the rib bones and muscles of the chest to remove the cancerous tissues, including the inner and outer linings and, if necessary, some of the lung tissue.
Extrapleural Pneumonectomy. This is an aggressive surgery, usually only recommended in rare cases. Dr. Sugarbaker developed and perfected this procedure over a 30-year period and he is considered the world’s leading authority on it. Like pleurectomy, an extrapleural pneumonectomy will remove all affected areas of the chest lining. But it also involves the removal of additional tissue, including the affected lung, portions of the covering of the heart (pericardium), and the diaphragm.
Illustration of a parietal pleura tumor. Panel (A) shows a cross-section of the right lung, where the tumor is forming along the lining of the lung tissue is shown in off-white. This tumor needs to be removed. Panel (B) illustrates how the lining is removed surgically. Source: Adult Chest Surgery, 2nd ed. David J. Sugarbaker
Illustration of extrapleural pneumonectomy. Clockwise from the top: The striped tissue represents the ribs and muscles between them, while the pink tissue below the surgical tool represents the lung to be removed in the procedure; The surgeon will create space between the ribs and the lung, removing the lung manually; In this image, the heart is depicted by the gray and yellow organ. In certain cases, part of the pericardium (tissue surrounding the heart) must be removed. This illustration shows the separation of the pericardium so that one section can be removed. Source: Adult Chest Surgery, 2nd ed. David J. Sugarbaker
After surgery, additional treatments (called adjuvant treatment) are usually offered in an attempt to gain more control over the disease. Typically, these involve radiation and chemotherapy.
At MTC, we make every effort to preserve as much lung tissue as we can. However, in some cases, resection of the lung is deemed necessary to achieving the surgical goal of complete resection of all tumor tissue visible to the naked eye. In these circumstances, if our team favorably assesses the patient’s ability to tolerate the procedure with a reasonable risk profile, we will consider removing the lung. In these kinds of complex cases, there is no substitute for our highly experienced surgeon and for our competent multidisciplinary medical team in order to optimize clinical outcomes.