Mesothelioma is a rare but aggressive type of cancer developed in the mesothelial cells and the result of asbestos exposure. Asbestos is a natural mineral widely used for about 100 years in industries like construction, shipbuilding, and manufacturing due to its heat resistance, tensile strength, and insulating properties. During the 20th century, it was shown to be toxic, as asbestos fibers can be released into the air when it is disturbed. These asbestos fibers can be inhaled or swallowed and become trapped in the body, irritating the cells and causing the formation of tumors.
Depending on the original location of the tumors, there are four different types of mesothelioma. When it occurs in pleura of the lungs, it is known as pleural mesothelioma, while peritoneal mesothelioma refers to the disease in the peritoneum, which is the lining of the abdomen. Pericardial mesothelioma occurs in the pericardium of the heart and testicular mesothelioma in the tunica vaginalis testis. In the case of peritoneal mesothelioma, the second most common type, chemotherapy and radiation therapy, as well as surgical procures like paracentesis, are among the treatment options.
Paracentesis Surgical Procedure
Patients who suffer from peritoneal mesothelioma may undergo a paracentesis to confirm the diagnosis or to relieve symptoms of stomach pain or difficulty breathing related to increased abdominal pressure and fluid buildup (ascites). The procedure is often performed as an out-patient surgery and it takes about 20 to 30 minutes. Patients are placed in a bed with their bladder emptied and with their head elevated at 45 degrees in order to allow the fluid to accumulate in the lower abdomen.
During the paracentesis, a needle is inserted into the abdomen to reach the peritoneal cavity, which enables its removal. The fluid start to flow and the needle is removed so that the drainage of the cavity occurs through an intravenous catheter. The usual levels of drainage are a maximum one liter at a time so that the body can balance the fluids and electrolytes. As the process is completed, the catheter is removed and the insertion site is covered with sterile dressing. If the paracentesis is to be repeated, the catheter and flow control valve may be left with a protective dressing. In the case of paracentesis being used as a diagnostic method, the fluid is analyzed to search for malignant cells.
Benefits of Paracentesis
For diagnostic purposes, it is known that paracentesis is not fully reliable and other methods are often necessary. But as a treatment option, paracentesis tends to be a preferable procedure, since it is a relatively safe and easy procedure, which involves a fast recovery. While a peritonectomy is a major surgery designed to resect the tumors from the abdomen, paracentesis is a minor surgery. Following the procedure, it is expected that patients improve their quality of life. Ascites are removed, causing improvements in digestive and respiratory symptoms associated to peritoneal mesothelioma.
However, ascites often reoccur and paracenteses may be repeated even as a palliative care.
Risks of Paracentesis
Being a simple procedure, a paracentesis does not comprise many risks. But there are, as it occurs with all other surgical procedures, the possibility of problems during or after the surgery. These include failing to collect the peritoneal fluid; infection of the insertion site; repeated leakage from the insertion site; collection of blood outside a blood vessel, which is also known as abdominal wall hematoma; perforation of the bowel, stomach or bladder, laceration of a blood vessel, and low blood pressure or postparacentesis hypotension. In addition, there are also other more rare occurrences.
“If peritoneal mesothelioma cells are present, there is a chance they could spread (called “seeding”) to the site where the needle was inserted. To make sure this doesn’t occur, radiation therapy may be used along the site of the incision,” explain The Mesothelioma Center. “Because peritoneal mesothelioma is rare, few studies have been done on the effectiveness of this procedure for this disease. While it is accepted as an effective method to control ascites, patients with the disease have a high rate of ascites recurrence. A disadvantage to paracentesis is that the patient must go to a hospital to have this procedure done. This can become costly and uncomfortable. If the patient necessitates frequent procedures, doctors may recommend the placement of a catheter instead.”