What Is the Typical Timeline for Mesothelioma Surgery?

[MUSIC PLAYING] When a patient for mesothelioma comes to see, for example, me, the idea is for initial consultation to assess whether or not they're an operative candidate. And if they are, the idea that I really try to push is that we need to try to do this within four weeks from when we have a diagnosis to even seeing me. And so what that is-- that's often harder to do than not, regardless of how close you are, but very doable. And so the idea is that you have four weeks to get-- once you've seen the consultation. If you can get surgery on the schedule into our operating room within four weeks, I think that's a success. If we look at the data-- and even when I was before the Brigham-- we were seeing a lag time of three to four months before patients were diagnosed and when they actually got their surgery. And so there's never been a definitive study looking at time to diagnosis and time to surgery outcomes. We do have a study that I've looked at with time for the outcomes for lung cancer. And we found lung cancer-- if you're diagnosed with lung cancer, at the time of diagnosis to time of surgery, the most optimal time in terms of the best survival and least amount of recurrence is actually four weeks. Now, lung cancer is different than mesothelioma. We know that. It's a different disease process. But that's something-- a basis that I've been using for, quote, unquote-- because for mesothelioma and for lung cancer. So when I do have a consult with the mesothelium patient, we really try to get them in four weeks. So that means they have the consultation with me virtually. Then they have to get the heart study, the lung study, and the lab work all within four weeks. And then we operate. Once we operate, the surgery itself, pleurectomy decortication, usually takes about four hours. It's a four-hour surgery that will involve general anesthesia. An epidural will be in place afterwards to help with some of the pain, so to minimize narcotic use. After the surgery, you're in the hospital from 7 to 12 days. The ICU stay is usually one to two days. And then after that, it's the regular floor, walking around, eating, all that for 7 to 12 days. Then, after that, it's about four to six weeks total of full recovery. But the majority of patients, more than 90% of patients, will go home. They'll go home as long as they have somebody around, whether it be significant other or family member, to kind of help things out in terms of the cooking and driving. But after that-- so a total of six weeks from the operation is the hardest part of the recovery. And then in terms of long term, it really is another two months, so a total of three months, where they're feeling excellent, per se, and they feel like they're really noticing a lot of the benefits. So that's kind of the time frame that I say. In terms of starting the chemotherapy, I usually like to start it within four to eight weeks after the day of surgery. That's usually the most optimal time that we try to get that in. But again, there is no data to show if four weeks after surgery versus three months after surgery for chemotherapy is OK. But preliminarily, when we look at it-- patients are further away or some are older and it takes them longer to recover. Say it takes them two or three months to recover after surgery. They can still get their chemotherapy, and we still see a beneficial effect if they get their chemotherapy even later afterwards. [MUSIC PLAYING]