Mesothelioma Treatments: Palliative Surgery -
Pleural
Catheters and Pleuroperitoneal Shunts
Pleurodesis is the most common palliative treatment
for
recurrent pleural effusions, but it is not an option for all patients with
pleural mesothelioma. Pleural effusions can seriously restrict
the lung’s ability to expand, even collapsing its supportive tissues, while
aggressive tumor growth along the visceral pleura can create a thick “rind”
around the lung itself, further preventing it from functioning normally. This
combination of symptoms can lead to a condition which causes, or at least
mimics, trapped lung syndrome, where a patient’s lung function is
significantly restricted and the fluid trapped in the pleural spaces cannot be
properly flushed out. In this situation, it may not be possible to perform any
of the standard
palliative treatments for pleural mesothelioma. Other patients may present
with a disease status that requires long-term draining of the fluid from the
lungs for other reasons as well. For these patient classes, pleural
catheters and pleuroperitoneal shunts
have been used to drain the excessive fluid build-up associated with pleural
effusions and to provide some relief from the pain and dyspnea associated with
them.
Pleural Catheters
A catheter is a thin, hollow tube that can be used to either withdraw fluid
from the body or deliver fluid into it. For the purposes of
mesothelioma treatment, a pleural catheter refers to a
catheter used to draw fluid from a pleural effusion out of the pleural cavity,
thereby reducing/removing the effusion and its attendant symptoms. Pleural
catheters are often used for the treatment of pleural effusions when more
effective procedures are not an option for individual patients.
The implant procedure is a relatively straightforward
process and can be completed on an outpatient basis.
Depending on the type of catheter installed, the patient may
be able to control the draining process him or herself, as
some companies have developed home catheter drainage kits
that are easily administered and maintained. Some catheter
types may still require assistive nursing however.
Many patients do report improved breathing and an overall
quality-of-life benefit with the use of pleural catheters,
but complications are not uncommon and the procedure is
purely palliative, i.e., it serves no curative function at
all. For these reasons, the long-term use of pleural
catheters for patients with
pleural mesothelioma is generally recommended only for
people ineligible for pleurodesis or another surgical
procedure and those with a shortened life expectancy.
Pleuroperitoneal Shunts
A shunt, like a catheter, is a thin, hollow tube implanted in the body to
correct a fluid imbalance. However, a shunt is used to divert fluid from one
part of the body to another, not to extract it from the body. A pleuroperitoneal
shunt, then, is a shunt that drains the fluid from a pleural effusion into the
peritoneum. A properly placed and maintained shunt can be used for years and is
an effective palliative treatment for patients with recurrent effusions.
However, pleuroperitoneal shunting is not generally
recommended for patients with pleural mesothelioma because
the fluid in the effusion is likely to be malignant, so
there is a risk that the tumor will be spread into the
abdomen. Other procedures have proven much more effective
for the treatment of pleural effusions and they hold less
risk for disease spread, but not everyone is eligible for
them. For these patients then, a pleuroperitoneal shunt can
greatly reduce the pain and discomfort that is associated
with pleural effusions and, therefore, lead to a real
quality-of-life improvement for them.
Related Information: Mesothelioma &
Surgery
For more information related to the surgical treatment of mesothelioma, please read the following:
|
