Surgery Options for Pericardial Mesothelioma


Pericardial mesothelioma is a rare and aggressive form of cancer that affects the lining around the heart, known as the pericardium. The treatment options for this condition are limited due to its advanced stage at diagnosis and the delicate area affected. However, surgical interventions can be considered for symptom relief and potentially to extend survival. Here are two primary surgical options:

1. Pericardiectomy

Pericardiectomy is a major surgical procedure that involves the removal of part or all of the pericardium, the lining around the heart. This surgery can be recommended for several reasons:

  • To relieve symptoms: Pericardial mesothelioma can cause the pericardium to thicken and restrict the heart’s movement, a condition known as constrictive pericarditis. Removing the pericardium can relieve these symptoms.
  • To extend survival: In some cases, if the mesothelioma is localized and has not spread extensively, removing the pericardium might help in controlling the spread of the disease.

2. Pericardiocentesis

Pericardiocentesis is a less invasive procedure compared to pericardiectomy and is primarily aimed at symptom relief, particularly for pericardial effusion, which is a common complication of pericardial mesothelioma. Pericardial effusion is the accumulation of excess fluid in the pericardial space, which can compress the heart and impair its function. The procedure involves:

  • Draining excess fluid: A needle is inserted into the pericardial space, often under ultrasound guidance, to remove the excess fluid. This can provide immediate relief of symptoms such as chest pain, shortness of breath, and swelling.
  • Preventing fluid recurrence: In some cases, medications may be administered through the same needle to prevent the reaccumulation of fluid.

Decision Making and Considerations

The choice between pericardiectomy and pericardiocentesis depends on several factors, including the patient’s overall health, the extent of the disease, and the primary goals of treatment (symptom relief vs. survival extension). Both procedures have their risks and benefits, and the decision should be made in consultation with a multidisciplinary team of specialists, including oncologists, cardiologists, and thoracic surgeons, who are experienced in treating pericardial mesothelioma.

It’s important for patients and their families to discuss all possible treatment options, including the potential outcomes, risks, and benefits, with their healthcare providers to make an informed decision that aligns with their goals and preferences.