Surgery

Medical opinion is divided about the benefits of radical surgery. You need to get the best possible advice about this as quickly as possible.

Pleural mesothelioma has 4 stages.

Stage 1 mesothelioma affects the pleura only.

Stage 2 mesothelioma has spread to both layers of the pleura on one side of the body only, and invaded the diaphragm or the lung.

Stage 3 mesothelioma has spread to the chest wall, central chest soft tissues or lymph nodes on the same side of the chest.

Stage 4 mesothelioma has spread to other organs in the body, or to lymph nodes on the other side of the chest.

Most doctors think surgery is only appropriate for otherwise fit and not elderly patients, in whom the mesothelioma has been diagnosed at an early stage.

Radical surgery called Extra Pleural Pneumonectomy (EPP) is being carried out in a small but increasing number of cases. This is major surgery. EPP involves the removal of the affected lung, the parietal pleura, the pericardium, and the diaphragm. The pericardium and diaphragm are replaced with a sheet of Gortex, or similar material. The surgery is often supplemented by chemotherapy before and after the operation, and by radiotherapy after the operation.

This type of surgery has not so far cured mesothelioma. It will reduce quality of life in the short term, and will leave the patient permanently with some breathlessness on exertion. The patients who have lived longest with mesothelioma have had this operation, combined with chemotherapy and radiotherapy.

Patients with epithelioid mesothelioma whose lymph nodes have not yet been involved tend to do better after surgery than other patients. However, patients in this category also do much better than average, even if not subjected to surgery.

A trial or test of the effectiveness of EPP, the Mesothelioma and Radical Surgery (MARS) Trial, is in progress. This is designed to find out the extent to which patients benefit from radical surgery in terms of increasing their life expectancy and the quality of life they have. All patients who go into this trial are given platinum based chemotherapy. Then, randomly, some go onto surgery (EPP), and others do not. Those who have surgery are later given radiotherapy. All of the patients are given the best pain killing (palliative) drugs available.

Another less drastic type of surgery is called Radical Pleurectomy and Decortication. The pleura affected by tumour is stripped from the chest wall. In some circumstances, this may help symptoms.