Mesothelioma Surgery Options And Recovery Process

Mesothelioma

Mesothelioma is a rare but aggressive cancer of the mesothelial tissue (specialized cells that line internal organs) and is caused by asbestos. It is often localized in the lining along the lungs (pleural) or abdomen (peritoneal).¹ This results in shortness of breath and chest pain due to lowered oxygen circulation, which causes chronic fatigue. Symptoms are not immediate and can take more than 10 years to experience.² As a result, 55% of the diagnoses are over the age of 75, and untreated mesothelioma patients have an average life expectancy of 12 to 21 months.³

Survival rate

Your occupation can put you at a higher risk of developing this form of cancer. The highest risk group involves those who work in professions like:

• metal plate workers-shipbuilding
• carpenters
• plumbers
• mechanics
• construction
• engineering⁴ 

The symptoms can be mistaken for many other health complications so Mesothelioma is often diagnosed at an advanced stage. Because of its aggressive characteristics, addressing this condition poses challenges in treatment, with most interventions focused on managing symptoms and curbing the advancement of cancer. Treatment includes a variation of surgical removal of tumours, chemotherapy, radiation, and immunotherapy. 

Stage 1- 60% survive for 1 year or more 

Stage 2- 55% survive for 1 year or more

Stage 3- 50% survive for 1 year or more

Stage 4- 30% survive for 1 year or more

By implementing these changes, the death rate caused by mesothelioma drops each year and it is expected to keep falling over the next 10 to 20 years.⁵

Types of mesothelioma surgery options

Pleurectomy/Decortication (P/D)

Pleurectomy/decortication (P/D) is a two-step surgical procedure that plays a crucial role in the treatment of mesothelioma. By combining resection of the tumour and removal of visible tumour masses, P/D allows an increase in survival rates and improves the quality of life for mesothelioma patients.⁶

Enhancing survival rates

P/D has shown promising results in terms of prolonging the survival of mesothelioma patients. A multimodal treatment approach involving P/D surgery followed by postoperative chemotherapy, radiation therapy, or immunotherapy, can effectively eliminate any remaining cancer cells. By attacking the disease from multiple angles, this combined approach ensures promising results.

Potential risks

Complications that may arise include infections, bleeding, air leaks, cardiac complications, respiratory failure, pneumonia, and postoperative pain. However, it is worth noting that the risk of respiratory failure following P/D surgery is relatively low, estimated at around 2.3%. The overall risk of failure with a mortality rate for P/D is approximately 3%, so close monitoring, and care allows a smooth postoperative experience and the patient can focus on recovery.⁸

Recovery and rehabilitation

The recovery process typically involves post-operative pain management, physical therapy, and respiratory exercises to improve lung function and overall well-being. While the length of the recovery period may vary for each patient, it is important to approach rehabilitation with patience and adhere to the guidance provided by healthcare professionals. By participating in rehabilitation programs, patients can regain strength, enhance their physical capabilities, and ultimately head for a speedy recovery.

Extrapleural pneumonectomy (EPP)

Extrapleural pneumonectomy (EPP) is a surgical procedure primarily recommended for patients diagnosed with early-stage pleural mesothelioma. By targeting cases in which cancer remains confined to the chest cavity, this treatment aims to remove a maximum amount of cancer cells. However, due to the often late-stage diagnosis of mesothelioma, many patients may not be eligible candidates for this surgery.⁹

Enhancing survival rates

EPP offers the potential to extend the life expectancy of mesothelioma patients. By combining the procedure with chemotherapy or radiation, patients may experience an increase in their lifespan. However, it is important to note that EPP carries a higher risk of mortality following surgery, and patients are advised to consider the safest option.^10,11

Potential risks

The most severe risk associated with EPP surgery is the possibility of death during or shortly after the procedure. A multicenter study published in 2014 highlighted the significantly higher mortality rate of EPP when compared to the less radical pleurectomy and decortication (P/D) procedure.¹²

Recovery and rehabilitation 

Following EPP surgery, patients can expect a recovery period of at least 6-8 weeks, and often longer. Even after six months, individuals may continue to face difficulties with exercise due to shortness of breath. Therefore, patients must undergo post-operative rehabilitation programs to regain strength and improve their overall quality of life.

Other surgical options 

Multiple treatment options have shown promise in enhancing survival rates for mesothelioma patients. These include chemotherapy, radiation therapy, immunotherapy, and targeted therapies. 

• Chemotherapy, often combined with surgery, can help shrink tumours and prevent their regrowth
• Radiation therapy can be used to kill cancer cells and provide pain relief
• Immunotherapy, such as immune checkpoint inhibitors, can help the immune system target and destroy cancer cells
• Targeted therapies, which focus on specific genetic mutations, aim to inhibit the growth and spread of mesothelioma cells

While these alternative treatments offer potential benefits, they also carry potential risks and side effects. 

Chemotherapy can cause nausea, fatigue, and weakened immune function. Radiation therapy can result in skin irritation, fatigue, and harm to surrounding healthy tissues. Immunotherapy can trigger immune-related side effects, such as inflammation and autoimmune reactions. Targeted therapies can have specific side effects related to the drugs used, such as skin rashes, diarrhoea, and liver problems. Patients need to discuss these potential risks and side effects with their healthcare team.¹³

Preparing for surgery

Evaluating eligibility

Determining eligibility for surgery in mesothelioma requires a thorough evaluation by a multidisciplinary team of experts. 

Eligibility is mainly assessed on factors such as the stage of cancer, location, and size of the tumour, response to prior treatments, general health, age group, and overall health.

A few tests including blood tests, ECG, lung function tests, chest X-ray, PET or CT scan to check for cancer spread, and MRI scans of the brain may be performed to form a prognosis and determine the suitability for surgery.¹⁴

Psychological preparation and support

It can be a very tough time for you and your family when undergoing surgery. It is important to have honest communication about your concerns with the medical team. Reaching out to friends, family, and loved ones for emotional support can help reduce stress.

Furthermore, there is a lot of information and pre-surgery resources available. It might be helpful to reach out to a nurse to be directed to the right information and educate yourself on the process to gain a sense of control and it can help calm the anxiety around the whole procedure. 

Remember to prioritise self-care and give yourself compassion during these times. 

If you’ve struggled with mental health problems before it can be normal for it to worsen and if you think that is the case for you please reach out to a healthcare professional so you can receive the right support.¹⁵

Recovery process

After undergoing an operation, it is common to have follow-up appointments to assess your well-being and address any concerns or issues you may have. These check-ups play a crucial role in monitoring your progress. Typically, individuals are discharged from the hospital within 7 to 15 days following the procedure. During this time, rest, proper nutrition, and adherence to post-operative instructions are essential for a successful recovery.

Immediate postoperative care

In the immediate post-operative phase, the medical team will closely monitor vital signs, manage pain, and address potential complications. To facilitate recovery, various drips may be administered, including a painkiller drip into the back, a urine collection drip, and a nasal-to-stomach drip for food. After abdominal mesothelioma surgery, the ability to eat and drink may be delayed. Your doctor will use a stethoscope to listen to your abdomen and determine when your bowel is functioning properly.¹⁶

Physical recovery and rehabilitation

The stitches or clips used to close your wound will typically remain in place for a minimum of 10 days. The removal of stitches is carried out by a practice, district, or hospital nurse, either at your home or at the hospital. 

It is encouraged to indulge in light exercise with gentle movement to enhance mobility and regain strength. Rehabilitation plans are usually personalised to the patient’s abilities.

Emotional and psychological recovery

Coping with the diagnosis, facing mortality, and adjusting to physical changes can be challenging. Seeking support from mental health professionals, support groups, or loved ones can aid in emotional healing and help develop effective coping mechanisms during this transformative period.

Life after surgery 

Post-surgery life might require adjusting to lifestyle changes. It's essential to focus on self-care, engage in activities that bring joy and purpose, and maintain regular communication with the medical team to monitor long-term health and well-being.

Follow-up care and monitoring

Your medical team will develop a personalised surveillance plan, which may involve blood tests, imaging studies such as CT scans and x-rays, as well as consultations to ensure ongoing monitoring of your health. 

It is crucial to inform your doctor if any new symptoms arise. You don't have to wait until your next appointment to address your concerns. Your doctor or nurse would prefer to be informed if something is troubling you.¹⁷

Coping strategies and lifestyle adjustments

In order to enhance overall well-being, it is important to maintain a nutritious diet and participate in regular exercise (with approval from the medical team). Seeking extra support through counseling or support groups is also a great step to take toward sustainable recovery.

Summary

Mesothelioma is an aggressive cancer that usually doesn’t get diagnosed until it progresses into advanced stages. However, the treatments (although tough) deliver promising results and there are lots of sources of support to help you get through the process. Adherence to your doctor’s advice and monitoring your lifestyle can help recovery.