One of the most common reasons to change surgical procedures for a patient with mesothelioma is for palliative care. This is the type of care a patient receives to improve symptoms and quality of life when there is little to no hope of a cure. Palliative care is all about relieving pain and bringing as much physical comfort and improved quality of life to a patient as is possible. These strategies may also be used in patients with a chance of being cured, but this is far less common.
Draining fluid is one of the most common types of palliative procedures. Fluid builds up between the two layers of the mesothelium as cancer develops, which causes pain and difficulty breathing around the lungs or heart and swelling and pain in the abdomen. Depending on where the fluid is removed the process may be called any of the following:
- Thoracentesis – which involves draining fluid from around the lungs
- Pericardiocentesis – which involves the removal of fluid from around the heart
- Paracentesis – which involves draining fluid from the abdominal cavity
Each of these procedures involves inserting a hollow needle between layers of tissue to draw out fluid. The strategy is not permanent, and as fluid builds up again the procedure will need to be repeated. In some cases, permanent indwelling catheters can be left in the lung or abdomen so patients can drain this fluid on their own at home, but this is not as common.
A pleurodesis is a type of surgical procedure aimed to prevent the ability of fluid to reaccumulate by eliminating the space between the lung layers. This procedure involves the creation of inflammation of the lining so that they stick together, leaving no space for the fluid to reaccumulate. A chemical pleurodesis involves instillation of a drug using a small incision in the chest cavity using a tiny camera. Common drugs used over the years include talc, bleomycin, tetracycline, doxycycline, or iodopovidone. A mechanical pleurodesis simply suggests manually irritating the pleura to generate inflammation. There is usually a chest tube left inside for a few days after the procedure. This helps remove any remaining fluid and provides additional suction for the lining to fully adhere together. The tube is then removed before the patient goes home.