The goal of most mesothelioma surgeries are the same: remove as much cancer as possible.

Pleural Mesothelioma Surgeries

There are two main categories of pleural mesothelioma surgery. Most top mesothelioma specialists treat each of their mesothelioma patients uniquely but their surgeries are usually categorized as one of the two main options. The most significant difference between the two is that the extrapleural pneumonectomy involves removing one of the patient's lungs. The pleurectomy with decortication was developed as a way for surgeons to leave their patients both lungs.

Extrapleural Pneumonectomy

The extrapleural pneumonectomy (EPP) was the first surgery developed to treat pleural mesothelioma. Since living with only one lung can be a radical change, it can be risky and is not usually recommended for late stage pleural mesothelioma patients.

During an extrapleural pneumonectomy (EPP) a surgeon removes the lung affected by mesothelioma, the pleura, the pericardium (the lining of the heart), and part of the diaphragm. Then the pericardium and diaphragm are reconstructed using a durable fabric patch.

Pleurectomy with Decortication

Pleurectomy with decortication (P/D) was developed by a mesothelioma surgeon to serve as an alternative to EPP. Some doctors believe that EPP is unnecessarily radical and have adopted the P/D as their prefered surgery.

The surgery involves removing the parietal (outer) pleura along with any affected tissues in the chest wall, diaphragm and/or pericardium. Then the visceral (inner) pleura is separated from the lung to remove any remaining visible tumors. P/D allows the patient to keep both of their lungs.

Peritoneal Mesothelioma Surgery

Cytoreduction with HIPEC

The most effective treatment for peritoneal mesothelioma is cytoreductive surgery with heated intraperitoneal chemotherapy (HIPEC). This procedure was developed starting in the 1980’s and has been perfected by specialists over time. Originally, it received significant backlash in the medical community for being too aggressive, but now it is considered the best way to improve the prognosis of a peritoneal mesothelioma patient.

Step One: Cytoreduction

Cytoreduction with HIPEC is complex and lengthy, averaging around 8-14 hours. Most of that time the surgeon is performing cytoreduction, which involves carefully removing tumors in the peritoneum and abdomen one by one.

The abdomen comprises 10 primary organs all lined by the peritoneum. Some organs affected by the cancer may need to be removed during this surgery.

Step Two: HIPEC

During a heated intraperitoneal chemotherapy (HIPEC) procedure, liquid chemotherapy is heated to approximately 107 degrees and circulated throughout the abdomen. It is intended to kill any remaining cancer cells left after a cytoreductive surgery. This direct contact with the tumors makes the chemotherapy more effective.

HIPEC usually lasts 60 to 90 minutes before it is flushed out of the abdomen. The side effects of this type of chemotherapy are less significant than those of chemotherapy administered intravenously.

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