Mesothelioma is a rare but aggressive type of cancer that occurs in the mesothelium, a membrane that covers some organs in the body. The cause for mesothelioma is exposure to asbestos, a natural mineral widely used for about 100 years in industries such as construction, shipbuilding, and manufacturing, given its heat resistance, tensile strength, and insulating properties. It was proven toxic during the 20th century since asbestos fibers can be released into the air if the material is disturbed. Asbestos fibers can be inhaled or swallowed and become trapped in the body, irritating the cells and causing the formation of tumors. There are four types of mesothelioma classified according to the origin of the tumors.
The most common type occurs in the pleura of the lungs and is known as pleural mesothelioma, while peritoneal mesothelioma refers to the disease in the peritoneum, which is the lining of the abdomen. In addition, pericardial mesothelioma occurs in the pericardium of the heart, and testicular mesothelioma in the tunica vaginalis testis. Pericardial mesothelioma accounts for about 1% of all cases and due to the proximity to the heart, and surgery is often an undesirable option. However, there are procedures available to patients, including pericardiectomy.
Pericardiectomy Surgical Procedure
Pericardiectomy is a surgical procedure meant to treat disease of the pericardium, including pericardial mesothelioma. Before the surgery, the patient is put asleep under general anesthesia and the surgeon starts by making an incision between the ribs. A mechanical spreader is used to spread the ribs and gain access to the heart. Then, the pericardium, which is the outer covering of the heart sac, is carefully stripped off and removed. A partial pericardiectomy consists of the removal only of the affected part of the heart lining and a total pericardiectomy on the removal of as much of the heart lining as possible.
During the surgery, the surgeon may also remove the fluid in the area and any tumor growth present. After completing the procedure, the breastbone and ribs are wired back together and the initial incision is closed using surgical stitches. The pericardiectomy is expected to relieve the symptoms of pericardial mesothelioma and increase life span, but it is not a common surgical procedure.
Benefits and Risks of a Pericardiectomy
The benefits of a pericardiectomy include relief of difficulty in breathing, chest pain, heart palpitations and fatigue, as well as inflammation of the pericardium (pericarditis) and buildup of fluid in the pericardium (pericardial effusion). However, it is an invasive cardiac surgery and there are numerous risks associated with it, such as the need for cardiopulmonary bypass during surgery, bleeding complications, the need for blood transfusion, and even death. Patients in advanced stages of mesothelioma are not usually eligible for pericardiectomy, while older patients, women and patients with other medical problems are particularly at risk for complications.
“All patients who underwent operation primarily for effusion with associated pain are alive and have improved functional capacity without steroid use. We conclude that pericardiectomy can be performed with low mortality and can result in good long-term survival and improved functional capacity. Patients who are seen primarily with pain refractory to steroid therapy can be relieved of symptoms with operation,” revealed the authors of the study “Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience,” who conducted a retrospective analysis of the records of 60 patients who underwent pericardiectomy between 1980 and 1990 at The Johns Hopkins Hospital.
Recovery and Life After a Pericardiectomy
After a pericardiectomy, the patient needs to stay in the hospital for one or two weeks, depending on the recovery path. Still in the hospital, the patient is given pain medication, while the recovery is monitored by a doctor or nurse. When the patient is able to go home, it will take a few weeks before going back to work. The results of the surgery vary and it may improve the patient’s prognosis or just alleviate the symptoms. In patients in earlier stages of pericardial mesothelioma the results can be better, while as palliative care, the effects on life span are reduced.
“One patient in advanced stages of pericardial mesothelioma received a pericardiectomy to relieve symptoms. Because the cancer had already spread beyond the initial site, the procedure had little effect on life span and the patient lived for eight months after the operation, explains The Mesothelioma Center. “In other patients with less progressed forms of the cancer, this surgery could have better results. In one mesothelioma patient, a pericardiectomy was followed by a chemotherapy regimen. This combination put the cancer into remission and the patient remained free of cancer at a three-year follow-up.”
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