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Mesothelioma Treatments: Palliative Surgery – Pleurodesis

Mesothelioma Overview

Mesothelioma is a rare, aggressive form of cancer that is almost always caused by asbestos exposure and is most commonly found in the outer lining of the lungs called the mesothelium. Most patients do not receive a diagnosis until after symptoms appear, which can be 30 years or more after exposure to asbestos, limiting their treatment options.   The prognosis for mesothelioma patients is usually grim with no known cures, and with the average survival time varying from 4 – 18 months after diagnosis.

Pleurodesis for Mesothelioma

A pleurodesis is a procedure that fuses together the parietal pleura and the visceral pleura, thereby obliterating the space between them. It is the most commonly-performed palliative treatment for patients with pleural mesothelioma because it helps prevent the most common symptom of the disease: pleural effusions, which are the result of fluid that builds-up in the pleural space. Pleural effusions can be quite painful and directly lead to shortness of breath (dyspnea), so a successful pleurodesis is an effective way to reduce some of the burdens associated with the disease.

Pleurodesis – Overview of the Procedure

Before the actual pleurodesis can be performed, the patient must have all of the fluid drained from his or her pleural cavity. Once the effusion has been drained and the pleural space emptied of fluid, the procedure can then begin. A pleurodesis is most commonly performed by introducing a chemical agent onto the surfaces of the two pleurae which causes surface irritation and inflammation. The pleural space is actually quite small, so the inflamed pleurae have only a small area in which to grow before their surfaces touch and the chemical “fusion” can be completed. A number of different agents have been used in the past, but contemporary treatment protocols specify talc as the standard agent deployed.

Although a chemical pleurodesis is the most common manner of performing pleurodesis, the procedure can also be performed surgically. In these situations, it is performed through thoracotomy or video-assisted thoracoscopic surgery (VATS). In a surgical pleurodesis, the surgeon will irritate one of the pleura—usually the parietal pleura—with a surgical instrument that causes it to become inflamed. The swollen pleura is then treated and fused to the visceral pleural, eliminating the space between them.

Pleurodesis – Treatment Considerations

Even though pleurodesis is an effective treatment for most patients with pleural mesothelioma, there are some downsides to the procedure. It can be quite painful to undergo, especially when performed through thoracotomy, so the patient must be sedated and then treated for the pain post-operatively.

However, the major problem associated with the procedure is that undergoing it can complicate further treatment. Because the very nature of the procedure is to bind together the pleural surfaces, curative surgical procedures whose effectiveness is based on the extraction of these tissues become more difficult, if not impossible, to perform. This is especially true for pleurectomy-decortication, where the visceral pleura and the parietal pleura are the major targets for resection. Patients who are set for an extrapleural pneumonectomy will be less compromised after pleurodesis compared to pleurectomy-decortication patients, but even for this group, a pleurodesis can complicate their surgery because the procedure adds another level of complexity to an already difficult surgery with historically high complication figures.

Pleurodesis – Conclusion

A pleurodesis will generally be performed on only those patients who are being treated palliatively. For patients who are not able to tolerate more advanced surgeries, such as a pleurectomy/decortication or an extrapleural pneumonectomy, successful pleurodesis is an effective treatment option in the management of symptoms. It can be combined with other treatments, such as palliative pleurectomy or a palliative decortication of the lung, for greater control of patient symptoms. However, for patients who may be candidates for curative surgeries, other options should be explored for the treatment of recurrent pleural effusions.

Related Information: Mesothelioma & Surgery

For more information related to surgical treatment, please read the following: