Understanding Mesothelioma Surgical Options
In the challenging landscape of mesothelioma, understanding the distinct surgical approaches for pleural and peritoneal forms of this aggressive cancer is crucial. In the world of mesothelioma surgery, top surgeons employ specialized techniques.
From pleural mesothelioma affecting the lung lining to peritoneal mesothelioma that arises in the abdomen, we’ll explore the intricacies of these surgical procedures.
Renowned specialists and top treatment centers dedicated to providing hope and healing will guide us through these critical facets of mesothelioma surgery.
Registered Nurse Amy Fair discusses mesothelioma surgery options and who may be a candidate. View Transcript.
Duration: 2 min 16 sec
What are the surgical treatment options for mesothelioma?
It’s important to talk to your surgeon and oncologist to see if you are a surgical candidate. Some folks that have extensive disease (cancer) are not a surgical candidate and they will start with other treatment modalities such as radiation and chemotherapy. With comorbidities such as diabetes, heart, and some lung conditions the surgeon may tell you you’re not a surgical candidate. Sometimes the cell type of your disease and the staging also drives if you are a surgical candidate or not for surgery.
Some of the surgeries performed for mesothelioma are a decortication, which is where they remove the lining of the lung, sometimes called a pleurectomy. There is a more extensive surgery called a pneumonectomy. That is where they remove the whole lung. There are surgical interventions for the peritoneal mesothelioma. Sometimes they will go in and do a recession of the damaged or diseased part of the intestines. There is a procedure called a HIPEC procedure where they go into the abdomen and they flood the abdomen with what is called a chemo wash. It is a more direct line and source of chemotherapy than the intravenous route.
Your surgeon will explain to you all the components of the surgery, pre-surgery, and post-surgery. They will tell you that you may have a chest tube. Many times, surgeries, decortications, things like that will cause the lung to collapse. That’s very normal so they will tell you that you may have a chest tube in place to inflate or to keep that lung from collapsing. Post-surgery it’s all about the healing phase. It’s about pain control. It’s about getting up and keeping your pneumonias down, getting up and being active. Post-surgery sometimes the patient is sent home with a catheter in their pleura called a pleura evac, pleura catheter where it continues to drain the fluid once the patient is at home. They will talk with them about good nutrition. They will talk with them about keeping their immune system strong so the healing process proceeded like it should.
Pleural Mesothelioma Surgery Options
The most common type of mesothelioma is pleural mesothelioma, accounting for roughly 85% of cases.
Malignant pleural mesothelioma begins in the lining of the lung (pleura). Symptoms of pleural mesothelioma usually develop anytime between 20-50 years after exposure to asbestos.
Some pleural mesothelioma patients may be eligible for either potentially curative or palliative surgery for mesothelioma. Unfortunately, in most cases, tumors have already spread too far to be completely removed.
Learn more about the types of surgery for pleural mesothelioma below.
Curative Surgery for Pleural Mesothelioma
If the cancer can be completely removed, the following potentially curative surgeries may be an option for pleural mesothelioma patients.
Even with curative surgery, cancer cells are often left behind — even when all the cancer that can be seen is removed. When this happens, the cancer cells may continue to grow and divide, causing cancer to return after mesothelioma surgery.
While doctors agree that surgery will not cure mesothelioma patients, it may help them live longer and improve their quality of life.
Get our Free Survivors Guide to read stories of patients living 10+ years after surgery and other treatments.
Extrapleural Pneumonectomy (EPP)
Some mesothelioma patients are eligible for extrapleural pneumonectomy (EPP) surgery.
EPP is generally only performed on patients in the early stages of mesothelioma when it hasn’t spread to the lymph nodes or grown outside the affected lung.
During EPP, the surgeon removes the patient’s diseased lung along with the pleura, diaphragm, and nearby lymph nodes. The pericardium, which covers the heart, may also be removed.
While EPP is considered major surgery, it may be a mesothelioma patient’s best chance for all visible signs of cancer to be removed. However, there may be significant drawbacks.
EPP drawbacks include:
- Between 5-10% of patients die during or shortly after this mesothelioma surgery.
- Roughly 1 in 3 patients may have major complications.
- It is often combined with chemotherapy or radiotherapy, making it hard for patients to tolerate.
- Patients must stay in the hospital for at least two weeks after mesothelioma surgery.
- After discharge, there’s an additional recovery period of 6-8 weeks while the body adjusts.
Potential EPP complications include:
- Bleeding
- Blood clots
- Changes in heart rhythm
- Fluid buildup in the chest
- Loss of lung function
- Pneumonia
- Wound infections
Since the mesothelioma patient’s ribs must be spread during EPP, the incision will likely hurt for a while, with activity being limited for 1-2 months.
EPP With HITHOC
During EPP, surgeons may deliver chemotherapy directly to the chest cavity in a procedure known as hyperthermic intrathoracic chemotherapy (HITHOC). Chemotherapy drugs are added to a heated saltwater solution with the goal of killing any remaining cancer cells. The chemotherapy solution is then removed, and the surgical incision is closed.
Pleurectomy with Decortication (P/D)
Pleurectomy with decortication (P/D) is a less extensive type of surgery for mesothelioma, although it is still a major operation.
In P/D, the pleura lining and pleura coating are removed on the side of the lung with the cancer. Unlike EPP, P/D mesothelioma surgery does not include removing the lung or diaphragm muscle.
Pleurectomy with decortication is used to treat early-stage (stage 1 and 2) pleural mesothelioma by removing as much of the tumor as possible from the pleural lining of the lungs and the surrounding chest cavity. Removing cancerous tissues in these areas reduces the spread of mesothelioma to nearby healthy tissues and organs.
P/D may be performed as a potentially curative mesothelioma surgery, but it can also be used for palliative measures to relieve pain and symptoms.
Some potential benefits of P/D surgery for mesothelioma include:
- Helping to control fluid buildup (pleural effusion)
- Improving breathing function
- Reducing pain
Some studies suggest that P/D is preferable to EPP because there are fewer problems associated with it.
P/D With HITHOC
Like EPP, P/D surgery is often paired with HITHOC or heated chemotherapy. The chemotherapy is administered right after the operation before the patient’s incision is closed.
Palliative Surgeries for Pleural Mesothelioma
Pleural mesothelioma can cause excess fluid to build up in the lungs (pleural effusion), leading to chest pain, coughing, and shortness of breath. Palliative surgery may be recommended to help relieve these and other symptoms.
Unlike curative (or therapeutic) surgeries, palliative surgeries do not aim to extend a patient’s life span.
Learn more about types of palliative surgery for pleural mesothelioma below.
Pleurodesis
If fluid is building up in the chest of a mesothelioma patient, a pleurodesis may be performed. In pleurodesis, a small cut is made in the chest wall, and a chest tube is inserted to drain fluid.
Talc or another substance is surgically applied between the two layers of the pleura (lung lining). The talc irritates the pleura and causes the layers to stick together. This removes the space between the lung and the chest wall (pleural space) so that fluid or air no longer builds up between the layers.
The chest tube is usually left in for 1 or 2 days to drain any newly accumulated fluids. Patients may need to stay in the hospital for a few days. With the reduction in fluid/air buildup, the lungs are able to expand fully, allowing the patient to breathe more easily.
If fluid returns and builds up in the chest, pleurodesis may need to be repeated more than once to control symptoms.
Thoracentesis
Thoracentesis is a surgical procedure performed in mesothelioma patients with fluid buildup. During a thoracentesis, a hollow needle is inserted into the chest to remove fluid from this area.
Patients may also hear this surgery referred to as pleurocentesis. It is less invasive than pleurodesis and does not require hospitalization. There may still be fluid leakage up to 72 hours after the procedure.
If the fluid returns later on, a catheter can be inserted to allow easier fluid drainage on a regular basis.
Catheter Placement
The PleurX™ catheter system allows mesothelioma patients to manage any excess fluid that comes back. A thin, flexible tube is surgically placed in the pleural space during an inpatient procedure that usually takes 45-90 minutes.
Once the catheter is inserted, the patient can easily drain the extra fluid at home using a special bottle. By regularly draining their catheter, patients can improve their breathing and avoid undergoing multiple thoracentesis surgeries.
Top Pleural Mesothelioma Surgeons
Dr. Raphael Bueno
Dr. Raphael Bueno is a renowned cardiothoracic surgeon specializing in malignant pleural mesothelioma. He serves as the Chief of the Division of Thoracic and Cardiac Surgery at Brigham and Women’s Hospital in Boston, where he has dedicated over 20 years to researching and treating different types of mesothelioma.
Dr. Robert Cameron
Dr. Robert Cameron performs surgery for mesothelioma at UCLA Medical Center in Los Angeles, where he is the director of the Comprehensive Mesothelioma Program. Dr. Cameron also serves as Chief of Thoracic Surgery at the West Los Angeles VA Medical Center, advocating for veterans with mesothelioma and helping them get the high-quality treatment they deserve.
Dr. Raja Flores
Dr. Raja Flores is the chairman for the Department of Thoracic Surgery at Mount Sinai Medical Center in New York. Dr. Flores is a recognized leader in the thoracic surgery field and is considered a pioneer in surgery for mesothelioma. He also established video-assisted surgery as the gold standard in treating lung cancer.
Dr. Harvey Pass
Dr. Harvey Pass is a cardiothoracic surgeon who serves as chief of the Division of Thoracic Oncology at New York University Langone Health’s Perlmutter Cancer Center. He’s been researching pleural mesothelioma for nearly two decades and pioneered immunochemotherapy as a mesothelioma treatment.
Dr. Taylor Ripley
Dr. Taylor Ripley leads the Mesothelioma Treatment Center at Baylor College of Medicine’s Lung Institute. He is also an associate professor of surgery at the college. Renowned mesothelioma specialist Dr. David Sugarbaker chose Dr. Ripley as Dr. Sugarbaker’s successor at Baylor. (Dr. Sugarbaker passed away in August 2018.) Dr. Ripley is known for his thorough expertise in thoracic and robotic surgeries.
Visit the UCLA Health website to learn more about Dr. Robert Cameron.
Mesothelioma Hope has no affiliation with and is not endorsed or sponsored by Dr. Robert Cameron. The information above is listed for informational purposes only. You have the right to contact Dr. Cameron directly.
Top Pleural Mesothelioma Treatment Centers
Some top cancer centers that treat pleural mesothelioma include:
- Brigham and Women’s Hospital (BWH) in Boston
- University of Chicago Medicine Comprehensive Cancer Center
- University of Texas MD Anderson Cancer Center in Houston
Peritoneal Mesothelioma Surgery Options
The second most common type of mesothelioma, peritoneal mesothelioma, forms in the lining of the abdomen (peritoneum) and has the best prognosis.
Surgery for mesothelioma of the peritoneum is performed to remove the tumor (potentially curative) or to ease symptoms (palliative).
Curative Surgery for Peritoneal Mesothelioma
Different types of potentially curative surgeries can be performed for peritoneal mesothelioma, but the most common operation is a two-part procedure called cytoreduction with HIPEC.
Cytoreductive and Debulking Surgery
Cytoreductive surgery, also called debulking, is a type of surgery for mesothelioma in which the entire peritoneum (lining of the abdomen) is removed.
The goal of debulking is to remove as many mesothelioma tumors as possible, which may also include removing parts of the bowels, gallbladder, liver, pancreas, spleen, and stomach.
This procedure has worked well for some mesothelioma patients, with half surviving 5 years after surgery.
Cytoreduction With Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Before cytoreductive surgery for mesothelioma is completed, surgeons may pump chemotherapy directly into the abdominal cavity, a process called hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC). After removing the mesothelioma tumors, the heated chemotherapy fluid bathes the surfaces where cancer cells may have remained. Once the chemotherapy is put in, the surgical incision is closed.
Omentectomy
Cancers in the peritoneum often spread to the omentum, a layer of fatty tissue covering the abdominal organs, including the stomach and large intestine.
When this occurs, the omentum may also be removed during debulking surgery for mesothelioma. This procedure is called an omentectomy.
Omentectomy patients typically stay in the hospital 2-4 days after surgery.
Palliative Surgery for Peritoneal Mesothelioma
Paracentesis
Paracentesis drains the excess fluid from the abdomen. During this procedure, Doctors insert a hollow needle into the abdomen to remove the fluid. A paracentesis is sometimes called an abdominal tap or an ascitic tap.
The surgery provides temporary relief from peritoneal effusion (ascites). Doctors may repeat the procedure as needed to manage the patient’s symptoms. Sometimes, doctors may recommend leaving a catheter in the peritoneal cavity to drain as needed.
We can help you connect with peritoneal mesothelioma surgeons and specialists close to your home. Try our Free Doctor Match today to get started.
Top Peritoneal Mesothelioma Surgeons
Dr. Richard Alexander
Dr. Richard Alexander is Chief Surgical Officer at Rutgers Cancer Institute in New Jersey. He is known internationally for his extensive research and for analyzing mesothelioma tumors at a molecular level. Dr. Alexander focuses on a combination of cytoreductive surgery and HIPEC to treat his patients.
Dr. Marcelo DaSilva
Dr. Marcelo DaSilva is the Medical Director of Thoracic Surgery at AdventHealth Orlando. He’s one of the few surgeons who treats both pleural and peritoneal mesothelioma. Recently, he launched one of the country’s newest mesothelioma programs, the Mesothelioma International Treatment program (MITp) at AdventHealth. Dr. DaSilva specializes in using heated chemotherapy during surgery.
Dr. Hedy Lee Kindler
Dr. Hedy Lee Kindler treats both pleural and peritoneal mesothelioma. She leads the mesothelioma treatment program and gastrointestinal oncology division at the University of Chicago. Part of Dr. Kindler’s work involves evaluating surgical treatment options for mesothelioma patients through clinical trials.
Dr. James Pingpank
Dr. James Pingpank is a surgical oncologist at the University of Pittsburgh Medical Center (UPMC) and an associate professor of surgery within the university’s School of Medicine. An expert in gastrointestinal cancers, he specializes in cytoreductive surgery and HIPEC. He also researches ways to improve the current standard of care for peritoneal mesothelioma treatment.
Dr. Mecker Moller
Dr. Mecker Moller leads the HIPEC peritoneal malignancies program at the University of Miami Sylvester Comprehensive Cancer Center. She was the first to perform a cytoreduction/HIPEC combination procedure in South Florida. Dr. Moller is also an associate professor of clinical surgery at The University of Miami Leonard M. Miller School of Medicine.
Top Peritoneal Mesothelioma Treatment Centers
Some top cancer centers that treat peritoneal mesothelioma include:
- H. Lee Moffitt Cancer Center in Tampa
- University of Pittsburgh Medical Center
- Washington Cancer Institute in Washington, D.C.
Get our Free Survivors Guide to read inspiring stories from patients who are thriving years after their diagnosis thanks to treatment.
Surgery for Other Mesothelioma Types
Surgery for mesothelioma cancer is not limited to the most common types. Patients with other types may also be candidates for mesothelioma surgery.
Pericardial Mesothelioma Surgery
Pericardial mesothelioma is a rare form that affects the heart’s lining (pericardium). It makes up only 1% of all cases and has the lowest life expectancy — 6 months to 1 year after diagnosis.
As for therapeutic (or potentially curative) surgeries, most pericardial mesothelioma patients undergo one of two procedures:
- Pericardiectomy: This surgery involves the removal of tumors by removing part or all of the pericardium.
- Tumor resection: Surgeons remove cancerous tumors without removing the pericardium.
Pericardiocentesis is a palliative surgery in which a surgeon uses a small catheter to drain excess fluid around the heart. This helps ease pressure and may relieve symptoms such as chest pain and shortness of breath.
Testicular Mesothelioma Surgery
Testicular mesothelioma is an extremely rare disease that causes cancerous tumors to form in the protective lining covering the testicles.
Mesothelioma surgery on the testicles is rarely done in an effort to cure the cancer. The procedure is usually only done when a cancerous tumor is mistaken for a hernia.
The most common surgery for testicular mesothelioma is inguinal orchiectomy, which removes one or both testicles and the spermatic cord. Most patients are able to resume their normal activities in 2-3 weeks.
Testicular mesothelioma patients may also undergo a lymphadenectomy to remove nearby affected lymph nodes. Recovery from a lymphadenectomy usually takes 3-6 weeks.
Recovery After Mesothelioma Surgery
The recovery process will look different for each mesothelioma patient depending on the type of surgery, their overall health, and whether there were any complications. Patients may need help getting around and will likely feel tired for several weeks or months after their mesothelioma surgery.
Patients should speak with their doctor before any procedure to determine a recovery plan for their condition and a specific type of surgery.
Generally speaking, it takes longer to recover from potentially curative (therapeutic) mesothelioma surgery than palliative (symptom-relieving) surgery. Therapeutic mesothelioma surgery is often more invasive and usually requires inpatient hospitalization followed by at-home recovery.
Estimated recovery times for common mesothelioma surgeries are shown in the chart below.
| Surgery | Recovery Time in Hospital | Recovery Time at Home |
|---|---|---|
| EPP | Up to 2 weeks | 6-8 weeks |
| P/D | Up to 2 weeks | 4-8 weeks |
| Cytoreduction with HIPEC | Up to 12 days | 8-12 weeks |
These recovery times are only estimates, and patients should listen to all doctor recommendations through recovery since each person will have a different path to recovery.
What to Expect During Recovery
After an invasive mesothelioma surgery, oxygen levels are monitored, with some patients needing an oxygen mask. Most mesothelioma patients can also expect to be connected to various tubes and drains after surgery.
The tubes and drains used in recovery from inpatient surgery may include:
- An intravenous drip to deliver liquids
- A tube (catheter) into the bladder to collect and measure urine
- A tube inserted in the nose to carry food and medicine to the stomach
- A tube into the back (epidural) to administer pain medication
- Drains coming out of the surgical wound(s)
While recovering from mesothelioma surgery, patients may also expect:
- Additional treatment, such as chemotherapy or radiotherapy
- Follow-up appointments
- Leg exercises to get them moving around, lessening chances of infections or blood clots
- Needing to take pain medication
- Wounds with stitches or clips with dressings covering them
What Are the Goals of Mesothelioma Surgery
When patients are diagnosed with mesothelioma, they require a specialized treatment plan. A doctor may recommend surgery to accomplish specific treatment goals with other treatments.
Patients must have a good understanding of the goals of each type of surgery so that they can play an active role in their own health decisions.
Surgical treatment goals may include:
- Eliminating mesothelioma completely from the chest, abdomen, or heart lining (potentially curative surgery)
- Improving the quality of life by relieving pressure from the chest, abdomen, or heart (palliative surgery)
- Preventing recurrence (when cancer comes back after treatment)
- Removing as many of the visible tumors as possible
The specific mesothelioma surgery performed depends on the following:
- Mesothelioma stage
- Cell type
- Location of the cancer
Regardless of the cancer stage, cell type, or location, combining surgery with mesothelioma chemotherapy and radiation therapy often achieves the best results for the patient.
Who Is Eligible for Mesothelioma Surgery?
Not every patient is able to undergo mesothelioma surgery, but some patients meet certain eligibility criteria.
Patients may be eligible for surgery if:
- They are in relatively good health.
- They are in the early stages of the disease.
- They have normal or near-normal organ function.
- They do not have sarcomatoid mesothelioma.
- Their mesothelioma has not spread to other areas of the body.
The patient’s doctor will help them determine if they’re a good candidate for surgery by reviewing their medical history, imaging scans, and biopsy results. However, all patients are advised to get a second opinion from a mesothelioma specialist before surgery.
Use our Free Doctor Match to find a local mesothelioma specialist who can confirm whether you qualify for surgery.
Preparing for Mesothelioma Surgery
Before proceeding with either surgery, doctors thoroughly evaluate the patient’s overall health and well-being.
This preoperative evaluation is a critical step to ensure that the patient is a suitable candidate for surgery. It involves assessing the patient’s physical health and ability to handle the surgery and recovery. Doctors will run tests to ensure the patient is healthy enough to undergo and recover from the mesothelioma surgery.
Even if a patient is healthy enough to undergo surgery for mesothelioma, it’s not uncommon for them to experience complications after the operation.
Common mesothelioma surgery complications include:
- Bleeding
- Blood clots
- Changes in heart rhythm
- Chest fluid buildup
- Damaged organs
- Infections
- Lung function loss
- Pain
- Pneumonia
- Respiratory problems
Surgical Prep Using Imaging Tests
Doctors also use imaging tests like positron emission tomography, computed tomography (PET/CT), and magnetic resonance imaging (MRI) to get a detailed view of the cancer’s spread, particularly whether it has crossed the diaphragm (a muscle that separates the chest and abdomen) or affected the opposite lung.
In some cases, if there are signs that the cancer has spread to the abdomen, doctors may recommend an exploratory laparoscopy, which involves using a small camera to examine the abdominal area visually.
Surgical Prep Recap
It’s also important for doctors to assess the patient’s overall quality of life and daily functioning, as surgery can significantly impact them. Quality of life may be temporarily reduced after both EPP and PD surgeries. EPP patients experience more pronounced effects on both physical and social aspects, lasting for about six months after surgery.
The preoperative evaluation is an essential step in the surgical treatment of mesothelioma. By carefully assessing the patient’s health, doctors can make informed decisions about the best course of treatment and help patients understand what to expect during and after surgery.
- Diagnostic surgery (biopsy) confirms mesothelioma and determines the cell type.
- Curative surgery removes all visible signs of mesothelioma.
- Palliative surgery relieves pain and symptoms associated with mesothelioma.
See If You Qualify for Mesothelioma Surgery
The Mesothelioma Hope team understands that making treatment decisions after a diagnosis can be overwhelming. We’re dedicated to helping patients navigate their diagnosis and find the best possible care.
Surgery and other mesothelioma treatments have helped many patients become survivors, allowing them more time to make memories with their loved ones.
Use our Free Doctor Match to connect with leading specialists who can determine the best treatment plan for your diagnosis.
FAQs About Mesothelioma Surgery
Can mesothelioma be removed with surgery?
Therapeutic (curative) surgery can be performed in an effort to remove all visible signs of mesothelioma. However, there’s still a chance that cancer cells could remain in the body after surgery.
These cancer cells may sometimes grow and divide, causing new tumors. For this reason, chemotherapy is often combined with surgery to eliminate the majority of remaining cancer cells and help extend the patient’s life span.
How long does mesothelioma surgery take?
Mesothelioma surgery can take as few as 30 minutes for an outpatient palliative procedure like thoracentesis or 12 hours for cytoreduction with HIPEC, which is much more invasive.
The patient’s doctor can provide a specific time frame for how long their mesothelioma surgery will take.
What are the chances of surviving mesothelioma?
The mesothelioma survival rate is generally calculated in 1, 2, and 5-year increments. The average survival rate is 73% for 1 year after diagnosis, 22.9% for 3 years after diagnosis, and 10% for 5 years after diagnosis.
Age, overall health, mesothelioma cell type, and type of mesothelioma can all affect an individual’s survival rate. Patients who do not receive mesothelioma treatment have a lower chance of surviving.
Can removing a lung cure mesothelioma?
Unfortunately, there is no permanent cure for mesothelioma. However, removing the cancerous lung during an extrapleural pneumonectomy (EPP) can help control tumor growth. Lung removal can delay the spread of the disease and improve breathing, and it may increase life expectancy when combined with radiation and chemotherapy.
According to the American Cancer Society, EPP has helped some patients live for years without cancer.
