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Surgical treatment of malignant mesothelioma

From Surgical treatment of malignant mesothelioma

Mesothelioma main Diagnosis Chemotherapy  

Surgery for malignant mesothelioma is rarely curative except in rare localized small tumors. Mesothelioma is usually present over a wide area along the pleural surface and it is rarely possible to surgically remove the whole tumor, except in very rare cases where it is present as an encapsulated mass and is not associated with pleural effusion. Role of surgery in diffuse pleural mesothelioma remains controversial. There are arguments on both sides favoring or prohibiting surgical resection of diffuse pleural mesothelioma. A combination of pleural effusion and bulky tumor makes surgical resection practically impossible. Radical surgery for mesothelioma is a major surgical procedure and this by itself is associated with high mortality and morbidity. Despite such radical surgical resection the mesothelioma often recurs. There are two basic surgical procedures that are usually performed in pleural mesothelioma. Extrapleural pneumonectomy (EPP) is a more extensive, radical surgical procedure and may remove more bulk compared to less extensive pleurectomy. Surgical interventions are not usually undertaken with an intention of cure but more often done for control of pleural effusion, or reduction of the bulk of tumor prior to chemotherapy or chemoradiation therapy. There are no clear guidelines for choosing one type of surgery over the other. The choice of the surgery will depend upon the extent of mesothelioma and the operating surgeon's preferences. The option of neoadjuvant or adjuvant chemotherapy combined with surgical resection is currently under active investigation for malignant mesothelioma in many centers. Long-term results with EPP are disappointing. Patients who had EPP have a median survival of 9.3 months to 17 months.

Since mesothelioma surgery is a radical procedure it is very important to make sure that the patient would be able to tolerate this procedure and the would have a reasonable quality of life after surgery. Extensive evaluation is often undertaken to determine the current pulmonary, and cardiac status of the person. This may include pulmonary function tests, evaluation of burden of asbestos exposure, evaluation of smoking history, and determination of presence of plaques or pleural thickenings. Cardiac assessment may include evaluation for hypertension, congestive heart failure, coronary artery disease, and cardiac rhythm status. It is also very important to rule out the presence of distant metastatic disease in patients who are being considered for surgery since presence of any such metastatic lesion would preclude the person from a tumor reduction surgery.

Cancer terms:
Remission: Partial or complete disappearance of tumor and cancer symptoms. Partial remission refers to decrease in the size of a tumor with partial relief of symptoms, while complete remission refers to complete disappearance of tumor and symptoms. Example: Mr. B had a large tumor, with three chemotherapy treatments, he had a partial remission and with six treatments he had complete remission. See cancer terms for more cancer related terms. Surgical treatment of malignant mesothelioma

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