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Surgery Author: Staff Editor Last Updated: Sep 7, 2017 - 10:06:33 PM

Pleural Mesothelioma: The Surgery Controversy Continues

By Staff Editor
Jun 23, 2015 - 10:01:53 AM

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( - Does surgery really help those with pleural mesothelioma? This is a question a lot of patients don't really understand the answer to, even when their doctor tries to explain it to them. Here's what this controversy is all about and how to make the right decision for you and your family.

Surgery - What Is It?

Surgery for mesothelioma is like any other surgery in the sense that it comes with the usual risks of surgery. There's a lot of controversy over this type of surgery, however, because not all patients experience the same results.

That's because there are different types of surgery. The most aggressive forms of surgery involve the complete removal of a lung, the lining around the lung, and the heart. Sometimes, portions of the diaphragm are also removed.

These surgeries are called extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D). They must be performed by specialists at hospitals like Mount Sinai. EPP is considered to be riskier than the P/D surgery, but both require experienced specialists in mesothelioma at a major cancer center.

Lowering the risk are new robotic surgery techniques, where machines do the surgery instead of humans.

Still, the remaining risk is the trauma caused to the remaining lung and blood loss.

Because of the inherent risks with the EPP, some doctors are moving away from complete lung removal, believing that lung-sparing surgery is a better option.

Sometimes, it's not the doctors - it's the patients. For patients who cannot benefit from lung removal because the cancer has spread or is inoperable, palliative surgery is an option. Palliative surgery attempts to improve quality of life.

There is no pretense that a cure is coming. Rather, the person is made as healthy as possible and is told to prepare for the end. Some patients elect this option because it makes living the rest of their life bearable. For example, Pleurodesis is a procedure that attempts to reduce fluid buildup, making it easier to breath and function.

Getting a Good Lawyer

Patients need a good lawyer for just about any mesothelioma case. Why? Because the process is almost always complex! Employers often have lawyers on their side working hard. The patient needs an experienced lawyer to fight for him.

Surgery is expensive, not just in terms of the actual operation, but in lost time from work. The money from a lawsuit could help pay for ongoing bills and expenses.

And, according to one asbestos lawyer, the onset of the illness may not appear until 30 or 50 years after the initial exposure. So, if a patient has worked in construction, mining, laundry service for workers who worked with asbestos, or a technical field that put him in close proximity to sources of asbestos, then he or she should seek out council immediately.

Mesothelioma is basically cancer that has been caused by chronic, low-grade, inflammation which has attacked the lining of the lungs and other organs.

Every year, 2,500 to 4,000 individuals are diagnosed with the illness or other asbestos-related diseases.

Extended Survival Times?

Some research shows that surgery was associated with longer survival rates, but that radiation didn't improve those results unless it combined with surgery.

The database for patients didn't include chemotherapy, which is, of course, part of standard treatment today.

Not all doctors agree that surgery improves outcomes, however. Some believe that there's nothing that can be done, and that surgery is simply a waste of time. Cancer is seen as degenerative.

But, the study showing positive outcomes from surgery came from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database. The data was compiled between 1973 and 2009, and the evidence shows females tend to survive longer than males, but only when they're younger and the diagnosis is made early on in the disease progression.

Most of the time mesothelioma patients are told that there's not a lot that can be done. But, the data show that survival rates with surgery and radiation were 42 percent after one year and 24 percent after three years. The five-year survival rates were 16 percent.

Without surgery, the survival rates plummet - 18 percent after one year, 10 percent after three and just 5 percent after 5 years.

In other words, most people with mesothelioma die before the fifth year following their diagnosis.

Unfortunately, because there's no solid causal proof that surgery improves survival rates, some remain skeptical. But, for surgeons that have performed the procedure, and have patients that are living 10 years later, it's a good sign.

Bill Murphy is a law professor. He likes to share his legal insights online. His articles can be found mainly on law and lifestyle websites.


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