Side Effects of Surgeries

Mesothelioma surgeries are often complex procedures. Surgeons must remove all of the visible tumor without damaging the vital organs the tumors may have grown on, such as the lungs or heart. Although many patients can benefit from debulking surgeries or palliative surgical treatments, not all patients will be candidates for these procedures.

A team of surgeons and oncologists will carefully evaluate each mesothelioma patient's current health - specifically their pulmonary function, previous treatment history and specific diagnosis before approving surgery as a viable treatment option.

Dr. Fontaine explains the complications with mesothelioma surgery.

Once the patient's specialist or treatment team approves the patient for surgery, he or she will be admitted to a treatment facility or cancer center. Many facilities require that patients stay in the hospital for monitored recovery so that any side effects that do arise can be properly managed.

Less radical surgeries such as a pleurodesis or thoracotomy are typically associated with the most minor side effects, while potentially curative surgeries come with a larger set of risks. For example, 64 percent of patients experienced at least one minor complication after a radical extrapleural pneumonectomy.

Malignant Mesothelioma Surgeries At A Glance

Extrapleural Pneumonectomy

Very radical. Used only on pleural mesothelioma patients. Surgeon makes a nine-inch incision and removes the entire affected lung, pleura and any other visible tumor.


Pleurectomy / Decortication

Somewhat radical. Used only on pleural mesothelioma patients. Surgeon makes one or two incisions, separates the ribs and removes the pleura/other visible tumor.


Thoractomy

Somewhat radical. Used only on pleural mesothelioma patients. Surgeon deflates the lung and removes all visible tumor, then places a tube in the chest to drain the remaining fluid.


Pleurodesis

Not radical. Used only on pleural mesothelioma patients. Surgeon inserts a thin tube into the chest and drains or suctions out any fluid. Talc may be "flurried" (inserted) into the pleural space to absorb extra fluid.


Paracentisis

Not radical. Used for peritoneal mesothelioma patients. Surgeon inserts a needle into the abdominal cavity and extracts the fluid.

Pain at the Incision Site

Group of Doctors about to perform surgery

The most common side effect experienced after a mesothelioma surgery is pain at the incision site. All procedures can cause discomfort where the knife or tube was inserted into the patient's body. This discomfort may be dull and tingling or more intense. For some patients, the pain will occur when they get up, sit down, walk around or try to perform daily activities. But for others, the pain may occur even at rest.

Quick tip: Mesothelioma patients with a chest or abdominal incision can benefit from placing a pillow over their incision when they cough to reduce extra pain caused by the motion.

What to tell your doctor when developing a pain management plan:

  • What pain you felt recently and how you managed it
  • How intense your current pain levels are
  • What pain medications you have taken recently
  • What vitamins or other supplements you are taking
  • Other prescription medications you are taking
  • Allergic or negative reactions to any other medications

Things to ask your doctor about pain medications:

  • What are the side effects?
  • What is the dose and how often should I take it?
  • Can I take an extra dose if I am still in pain?
  • What, if any, non-prescription medications, vitamins or other supplements I should avoid while taking this?
  • Why are you choosing this particular drug over others?

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Your surgeon can help you develop a pain management plan to cope with pain you might experience after your surgery. Before you leave the hospital your doctor will most likely provide prescriptions for general nerve blockers or oral pain relievers. These can include prescriptions for narcotics like Morphine for severe pain, or Vicodin for moderate pain, just to name a few. Or your doctor may advise you to take over-the counter (OTC) medications like acetaminophen (Tylenol), ibuprofen (Advil) or naproxen (Aleve) to relieve mild pain. Any OTC medications should not be taken after surgery without specific instructions from your doctor.

Fast Fact: Make sure to get your prescriptions before or immediately after being discharged from the hospital so that you have them available at the first sign of post-operative pain.

Swelling, Drainage and/or Infection at the Incision Site

Whenever a foreign object such as a needle, knife or tube is placed into the body, swelling or drainage are normal side effects. In fact, open drainage is recommended during the healing process. Mesothelioma patients may notice inflammation or fluid accumulation at the incision site.

Common incision sites for mesothelioma surgeries include:

  • Extrapleural pneumonectomy- Incision begins on the patient's back under the shoulder blade and continues to the space at the sixth rib.
  • Pleurectomy/decortication- Incision is made on the patient's abdomen above the fifth rib; incision may also be made at the seventh rib if the diaphragm is affected.
  • Thoractomy- Incision is made under the arm/breast or between the ribs.
  • Pleurodesis- Surgeon makes either one large incision from the shoulder blade to the ribs OR several small ports on the patient's side.
  • Paracentisis- Needle is inserted directly into the abdomen.

Mild swelling, draining or bruising of the injured tissues are common and will usually resolve themselves on their own within a few days or weeks. But if any of these symptoms occur in excess, you should contact your doctor. Excessive inflammation or foul-smelling drainage at the surgery site may be a sign of infection, so call your treatment team right away if this happens. Other signs of infection include redness and a warm/tingling sensation. Post-operative infection should be controlled under a doctor's care, but it is imperative to report it immediately to prevent the infection from becoming fatal.

Bleeding

Bleeding at the incision site is also normal after a surgery for mesothelioma. Most patients will experience minimal bleeding that poses no threat to overall health, and the body will be able to regenerate any blood that has been lost. However, some patients may begin bleeding at the incision site during their recovery. This may occur spontaneously or as the result of over-stretching or otherwise damaging the incision area.

Patients can control bleeding by gently cleaning the area, applying a dry dressing and contacting their doctor for further instructions. Patients can also quickly and easily control bleeding by applying light, direct pressure. If bleeding becomes extensive, seek immediate attention. Call 911 if you begin to lose large quantities of blood.

Fatigue

Even after any anesthesia wears off, patients may still feel fatigued from the basic bodily stress that occurs with an invasive procedure, especially a major operation such an extrapleural pneumonectomy or a pleurectomy/decortication. The body requires a large quantity of energy to heal itself, often leaving little energy for the patient to perform daily activities. The fatigue may be intensified if the patient does not eat enough food or get enough rest to restore the body's energy levels.

Quick tip: To help combat fatigue, patients should nap when they feel exhausted and/or increase the frequency of their meals.

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Cardiac Complications

Mesothelioma surgeries performed in the chest cavity pose the risk of causing cardiac complications. The most common risk is for atrial fibrillation, or cardiac arrhythmia (irregular or abnormal heart beat). In one study of 328 patients who underwent an extrapleural pneumonectomy, more than 44 percent experienced an abnormal heartbeat after the surgery.

Patients may experience other cardiac complications after a chest surgery, including inflammation, compression of the heart from a fluid buildup or myocardial infarction (heart attack). Cardiac arrest may occur, but it is very rare, affecting only 3 percent of the patients in the extrapleural pneumonectomy study. If cardiac arrest occurs within 10 days of the procedure, patients may require an emergency thoracotomy to surgically correct the shifted heart.

Unlike other side effects, these conditions cannot be managed by medication or other techniques.

Average Length of Recovery in the hospital (in Days)

Other Surgical Complications

In one study of 33 extrapleural pneumonectomies, eight patients experienced major operative complications.

The complication rates are broken down as follows:

  • Abnormal growth between the lung and pleural space (2 patients)
  • Vocal cord paralysis (2 patients)
  • Pleural effusion (1 patient)
  • Buildup of lymphatic fluid in the pleural cavity (1 patient)
  • Arrhythmia/Erratic heartbeat (1 patient)
  • Respiratory failure (1 patient)

Some of the other rare complications include kidney failure, hypotension (low blood pressure), deep vein thrombosis (blood clot that usually occurs in the large veins of the legs), air leak, hemorrhage and aspiration.

Peritoneal mesothelioma patients who receive surgery in their abdomens may experience temporary bowel paralysis for a short time after surgery. This may prevent patients from emptying their bowls, which can also result in nausea or vomiting. Often, the body can heal itself of this problem, but some patients may need a catheter during recovery if this blockage continues.

Additional Resources

  1. American Society of Clinical Oncology – Side Effects of Cancer Surgery. (2011 March 30). Retrieved from: http://www.cancer.net/patient/All+About+Cancer/Cancer.Net+Feature+Articles/Side+Effects/Side+Effects+of+Cancer+Surgery
  2. Cleveland Clinic – Pain Control After Surgery. (2009). Retrieved from: http://my.clevelandclinic.org/services/pain_management/hic_pain_control_after_surgery.aspx
  3. DaValle, M. (1986). Extrapleural pneumonectomy for diffuse, malignant mesothelioma. Annals of Thoracic Surgery, 42, 612-618. Retrieved from http://ats.ctsnetjournals.org/cgi/reprint/42/6/612?ijkey=410e3ea6616ada51fc1fc5ae4ab73f03ae296961
  4. Little, A., & Merrill, W. (2010). Complications in cardiothoracic surgery: Avoidance and treatment. (2ND ed.). Hoboken, NJ: Blackwell Publishing.
  5. National Library of Medicine. Deep Vein Thrombosis. (2011). Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000156.htm
  6. Sugarbaker, D. (2004). Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies. Journal of Thoracic and Cardiovascular Surgery, 128, 138-146. Retrieved from http://jtcs.ctsnetjournals.org/cgi/reprint/128/1/138?ijkey=3e939a9f078505be8d20fbb70eb16b5833d28558
  7. United States Drug Enforcement Administration. (n.d.) Morphine. Retrieved from: https://www.dea.gov/druginfo/drug_data_sheets/Morphine.pdf

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