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Palliative vs Curative Surgery

Nurse treating elderly patient

Mesothelioma surgery can have several goals, including completely removing the cancer, preparing a tumor for other treatment types and relieving pain. Learn the difference between palliative and curative surgery to make more informed treatment decisions.

It's never easy learning that you or a loved one has mesothelioma, neither are the decisions that follow. Once you process the news and reality sets in, try to focus on treatment plans the oncologist offers. You may be asked to choose what type of treatment you want to pursue, and that can include deciding between curative or palliative surgery.

Top doctors who treat asbestos-related cancers almost always look at surgery as a first option. They can cite a number of medical studies showing that successful surgery, when combined with other treatments, leads to longer survival. If you are not dealing with a late-stage cancer and you consider your overall health to be good, you may be able to choose a more aggressive treatment.

Both types of surgeries have advantages and disadvantages. You’ll be in a good position to decide between palliative and curative surgery if you understand the disease, and if you are honest about what you want to endure and what quality of life you expect after treatment.

Based on other case histories and personal experience, the oncologist likely will steer you in one direction or the other.

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Differences Between Palliative and Curative Surgery

Doctors performing surgery

Doctors push for potentially curative surgery to remove all visible tumor growth if the tumor is in its early stages and is localized to a specific area of the body. This type of surgery is designed to cure a patient from a disease, promote recovery or extend life.

Curative surgeries are often complicated procedures. You should consult your doctor about the benefits and risks involved before making any decisions on your treatment plan.

While curative surgery focuses on significantly improving life expectancy, the primary goal of palliative surgery is to relieve pain and reduce other symptoms to increase your quality of life. Palliative treatment can also make you more comfortable, which can help you cope physically and mentally during your fight against this aggressive cancer.

Pain management is the top priority for this type of surgery. A team of doctors, nurses and other specialists work together to provide an extra layer of support for people diagnosed with cancer. You can receive this type of treatment at any age and stage of illness. It also may be combined with a curative treatment.

When Is Curative Surgery an Option?

If you were recently diagnosed with early-stage mesothelioma, potentially curative surgery may be the optimal treatment option to improve your prognosis, especially when doctors use it as a multimodal approach that also includes other treatment options, including chemotherapy and radiation.

In a study of 120 patients, researchers examined the effectiveness of trimodal therapy in the treatment of malignant pleural mesothelioma in cases dating from 1980 to 1995. The patients underwent extensive surgery followed by a combination of chemotherapy and radiotherapy. Overall survival rates were 45 percent at two years and 22 percent at five years. This means patients are approximately 15 percent more likely to live past two years if they receive a multimodal treatment plan.

In most cases, potentially curative surgery is likely to improve your life expectancy if your cancer has not spread (metastasized), if it is relatively contained to the lining of the lungs or abdomen, and if an experienced surgeon is able to remove all visible signs of the tumor.

You may be eligible for this type of surgery if you are in otherwise good health, your body is strong enough to withstand any complications or side effects of surgery and if the cancer has not spread to the lymph nodes or surrounding organs.

Curative Surgery Types

There are two types of potentially curative surgeries to treat pleural mesothelioma and one to treat peritoneal mesothelioma. Although these procedures may extend your life expectancy, they do not come without risks. You should consult your doctor about the benefits and risks associated with each procedure.

  • Extrapleural Pneumonectomy

    EPP

    Extrapleural Pneumonectomy

    This type of surgery treats pleural mesothelioma. It involves removing the cancerous lung, as well the lining of the lungs, the lining of the chest, nearby lymph nodes and part of the diaphragm. It is a serious, complicated procedure, but it may be the most effective way to control tumor growth.

  • Pleurectomy/Decortication

    P/D

    Pleurectomy/Decortication

    A P/D is considered the lung-saving surgical option. Instead of removing the cancerous lung, a surgeon removes the lining around the lung and chest (the pleurectomy) and any visible tumor growth (decortication).

    In one of the largest and most recent studies comparing the outcomes of 1,145 patients treated with these surgeries, median overall survival for P/D ranged from 13 to 29 months compared to 12 to 22 months for EPP. P/D also had significantly lower rates of deaths and complications.

  • Hipec

    HIPEC

    Hyperthermic Intraperitoneal Chemotherapy

    In this promising new two-part procedure, doctors remove peritoneal tumors with cytoreductive surgery, close the incision and then bathe the abdomen in a heated chemo solution. The chemotherapy agent, heated to improve its effectiveness, aims to kill any microscopic cancer cells left behind after surgery. A recent European study involving more than 100 patients treated with HIPEC mentioned 26 patients who survived more than five years after the procedure. It also noted 19 patients who survived seven years after the procedure. Study authors claimed they appear to be cured.

When to Consider Palliative Surgery

Palliative surgery may be the right choice for patients who:

  • Decide against curative treatment options
  • Suffer side effects from past curative treatments
  • Have advanced cancer spread

Unfortunately, mesothelioma is an extremely aggressive cancer and those who are diagnosed in its later stages may not be eligible for curative surgeries. At this time, the best option may be palliative treatments that offer a better quality of life and eliminate or reduce side effects the disease causes.

When a person is older and not as strong as they once were, the goal becomes not to cure the disease, but to make the best of the time they have left and to live comfortably without the burden of going through more rigorous treatment options.

Palliative surgery is also an attractive option for those who have already undergone a potentially curative surgery and are experiencing pain and side effects. To help combat the side effects of extensive, curative surgeries, patients elect to undergo palliative surgery. It is appropriate at any cancer stage and can be combined with most curative options.

Sometimes curative treatments do not respond as well as doctors initially anticipated. In this case, some people with this disease may transition from curative options to palliative options.

Palliative Surgery Types

There are a number of surgeries that can help alleviate pain associated with mesothelioma. Talk to your doctor about any symptoms or pain you’re feeling. You may have options.

Below are a few of the most common palliative surgeries for different types of this aggressive cancer.

  • Pleurodesis

    Pleurodesis

    Treats pleural effusion in the chest

    This procedure clears excess fluid buildup in the lungs that can cause shortness of breath and discomfort for people with pleural mesothelioma. Doctors insert a hollow tube into the chest wall, drain the fluid and add a substance to seal the space, protecting it from further fluid buildup. However, an article in the medical journal Thorax shows one-third of patients will require another drainage procedure, suggesting that thoracentesis is a better option.

  • Thoracentesis

    Thoracentesis

    Pleural space not sealed after draining

    A thoracentesis is relatively the same procedure as a pleurodesis with the same goal, to extract fluid buildup in the lungs. However, this procedure does not close the pleural space, which means the fluid may return.

  • Abdominal Paracentesis

    Abdominal Paracentesis

    Removes fluid buildup in abdomen

    Surgeons perform this procedure on peritoneal mesothelioma patients. This helps to alleviate stomach pain and difficulty breathing. Doctors insert a needle into the peritoneal cavity and the fluid is drained through an intravenous catheter.

  • Pericardiocentesis

    Pericardiocentesis

    Eliminates fluid buildup around heart

    Relieves pain for people with pericardial mesothelioma, the rarest form of this asbestos-related disease.

  • Thoracotomy

    Thoracotomy

    Cut surgeons make to access the chest cavity

    This is a surgical incision into the pleural space or the chest cavity to access the lungs, heart, esophagus, aorta, trachea or diaphragm. For someone with mesothelioma, this procedure can include any of the following:

    • Wedge Resection

      Also known as a segmentectomy, a wedge resection is the removal of small wedge-shaped part of the lung. This is often done when the cancer is confined to a single area.

    • Lobectomy.

      A more complicated procedure is the removal of one of five lobes in the lung, which is referred to as a lobectomy. This is done if the tumor is confined to a single lobe.

    • Pneumonectomy.

      This is the most extensive of the three options. It involves removing the entire lung and can only be done if the cancer has not spread beyond the lung.

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