What to Know About Surgery for Mesothelioma
Surgery is one of the most effective treatments for mesothelioma. Mesothelioma surgery allows doctors to remove tumors so the cancer can’t grow and spread.
In turn, mesothelioma patients often have improved life expectancies — sometimes living for 15 years or more — depending on how their body responds to the 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.
Types of surgery for mesothelioma include:
- Cytoreduction with HIPEC: Surgeon takes out tumors from the abdominal lining (peritoneum) and then applies a heated chemotherapy solution to the area.
- Extrapleural pneumonectomy (EPP): Doctors remove cancer tumors, the lung nearest to the cancer, and the lining of the lungs (pleura).
- Pleurectomy with decortication (P/D): The pleura and cancer tumors are taken out, but both lungs are left intact.
- Palliative surgeries: Surgical procedures are performed that focus on relieving painful symptoms and improving quality of life.
Work with Mesothelioma Hope to find top doctors who can use surgery and other mesothelioma treatments to help you live longer. Use our Free Doctor Match to get started.
Surgeries for Pleural Mesothelioma
Doctors typically treat malignant pleural mesothelioma (which forms in the lining of the lungs) using either an EPP or a P/D.
Learn about each of these mesothelioma surgeries below and how they may help you or a loved one with this cancer.
Extrapleural Pneumonectomy (EPP)
With an extrapleural pneumonectomy, a surgeon removes the lung closest to the cancer, the pleura, and parts of the diaphragm and the heart lining.
Pleural mesothelioma patients who received an EPP with heated chemotherapy (HITHOC) lived for 38.1 months on average, according to a 2022 study published in Translational Lung Cancer Research. This is more than double the average pleural mesothelioma life expectancy of 18 months.
Patients must be in good overall health to receive an EPP, since it’s a major surgery and involves a lengthy recovery period.
Pleurectomy With Decortication (P/D)
A pleurectomy with decortication is the other major pleural mesothelioma surgery option.
With a P/D, the surgeon removes the pleura and all cancer tumors they can see like in an EPP. However, doctors won’t remove a lung, so patients have an easier recovery.
A 2021 study published in the Journal of Thoracic Disease found that pleural mesothelioma patients who received a P/D lived for 34 months on average. This 16 months longer than the average pleural mesothelioma life expectancy.
Because it can help pleural mesothelioma patients live longer and is less invasive than an EPP, the P/D is often the preferred pleural mesothelioma surgery.
Call our team at (866) 608-8933 to get help finding a pleural mesothelioma surgeon and scheduling your initial consultation.
Surviving Pleural Mesothelioma: John’s Surgery Story
Pleural mesothelioma survivor John Panza is still alive today — more than 10 years after his diagnosis — thanks to surgery.
John was diagnosed in 2012 at the age of 38. While he never worked directly with asbestos (the only known cause of mesothelioma), his father did during his time at a brake company. It’s believed John was exposed secondhand and that this caused his cancer.
After being diagnosed, John quickly underwent an EPP along with chemotherapy and radiation therapy. This combination of treatments sent John’s cancer into remission for several years.
“I’ve had a recurrence of meso in 2019. I had a lymph node taken out that was cancerous, and I’ve had a little bit of chemo since then. But, you know, for the most part, I’ve been fine.”
Already working with a specialist? Bring our Free Doctor Questions Checklist to your next appointment to help guide your conversations about surgery and other treatments.
Palliative Surgeries for Pleural Mesothelioma
Palliative surgeries can help ease symptoms of pleural mesothelioma, most notably fluid buildup in the lungs (pleural effusion). Effusions cause chest pain, coughing, and shortness of breath.
Learn about the types of palliative pleural mesothelioma surgeries below.
Pleurodesis
With a pleurodesis, a small cut is made in the chest wall, and a chest tube is inserted to drain the effusion. Then, doctors insert talc or another substance so the two layers of the pleura stick together. This prevents fluid from building up again.
Thoracentesis
During a thoracentesis, a hollow needle is inserted into the chest to remove fluid. It’s a less complex surgery than a pleurodesis and only takes 15 minutes, but fluid could build up again.
Catheter Placement
The PleurX™ catheter system allows mesothelioma patients to manage fluid that keeps building up even after it’s been drained. A thin, flexible tube is surgically placed in the pleural space during a minor surgical procedure that usually takes 45-90 minutes.
Once the catheter is inserted, the patient can drain pleural effusions at home using a special bottle. This saves the patient from having to go back to the hospital to get the fluids drained.
Top Pleural Mesothelioma Surgeons
Dr. Raphael Bueno
- Brigham and Women’s Hospital, Massachusetts
- 20+ years of experience
- Leader of International Mesothelioma Program (largest in the world)
- Uses surgery and other treatment options to help patients
Dr. Robert Cameron
- UCLA Medical Center, California
- 25+ years of experience
- Invented the P/D surgical technique
- Director of UCLA’s Comprehensive Mesothelioma Program
Dr. Raja Flores
- Mount Sinai Medical Center, New York
- 20+ years of experience
- Chief of Thoracic Surgery at Mount Sinai
- Can treat patients using either an EPP or P/D
Dr. Taylor Ripley
- Baylor College of Medicine, Texas
- 15+ years of experience
- Leads Baylor’s Mesothelioma Treatment Center
- Uses thoracic and robotic surgeries to treat patients
We can help you schedule appointments with mesothelioma surgeons and specialists close to where you live. Try our Free Doctor Match today to get started.
Surgery for Peritoneal Mesothelioma
Peritoneal mesothelioma surgery allows doctors to remove tumors from the lining of the abdomen. Aggressive peritoneal mesothelioma surgeries can help patients live for many years, with some going on to become long-term survivors.
Learn about peritoneal mesothelioma surgery options below.
Cytoreduction With HIPEC
Cytoreduction with HIPEC is the most effective peritoneal mesothelioma surgery.
It’s a two-part procedure that involves:
- Removing all cancer tumors from the abdominal cavity with cytoreductive surgery (also called debulking)
- Soaking the surgery site with HIPEC (hyperthermic intraperitoneal chemotherapy) to kill any cancer cells left behind
Peritoneal mesothelioma patients live for 53 months (4.5 years) on average if they undergo this treatment.
Cytoreductive Surgery Success: Alexis’s and Julie’s Stories
Some peritoneal mesothelioma patients have lived for decades after diagnosis when treated with cytoreductive surgery and HIPEC.
The inspiring stories of two mesothelioma survivors — Alexis and Julie — are included below.
Alexis Kidd
Alexis was diagnosed with peritoneal mesothelioma following gallbladder surgery in 2007 when she was in her early 30s.
But, thanks to cytoreduction with HIPEC, she is still living today, nearly 20 years after her diagnosis. Alexis credits the care and support she received from her medical team and husband for her survival.
Julie Gundlach
Julie was diagnosed with peritoneal mesothelioma in 2006, and her health care team initially gave her only 6-12 months to live.
After her diagnosis, she was worried that her daughter would grow up without a mother.
Julie decided to fight the cancer, undergoing multiple cytoreduction with HIPEC surgeries. She survived and is now considered a long-term survivor — and recently got to send her daughter off to college.
Omentectomy
This peritoneal mesothelioma surgery is often recommended if a patient’s cancer has spread to the omentum, a layer of fatty tissue covering the abdominal organs like the stomach and large intestine.
Doctors remove the omentum during an omentectomy and can perform the procedure during a general cytoreduction.
Palliative Surgery for Peritoneal Mesothelioma
Doctors may use palliative surgeries to drain fluid buildup from the abdominal lining (ascites), helping to ease symptoms of this cancer. The most notable palliative surgery for peritoneal mesothelioma is called a paracentesis.
Paracentesis
During a paracentesis, doctors insert a hollow needle into the abdomen to remove abdominal fluid.
Doctors may repeat the procedure as needed to manage the patient’s symptoms. Sometimes, your cancer care team may recommend leaving a catheter in the peritoneal cavity to drain as needed.
Top Peritoneal Mesothelioma Surgeons
Dr. Richard Alexander
- Rutgers Cancer Institute of New Jersey, New Jersey
- 25+ years of experience
- Chief Surgical Officer at Rutgers Cancer Institute
- Internationally recognized mesothelioma surgeon
Dr. Marcelo DaSilva
- AdventHealth Orlando, Florida
- 15+ years of experience
- Medical Director of Thoracic Surgery at AdventHealth Orlando
- Treats both pleural and peritoneal mesothelioma
Dr. Hedy Lee Kindler
- University of Chicago Comprehensive Cancer Center, Illinois
- 20+ years of experience
- Director of the Mesothelioma Program at UCCCC
- Treats patients using surgery and conducts clinical trials
Dr. James Pingpank
- University of Pittsburgh Medical Center, Pennsylvania
- 20+ years of experience
- Director of UPMC’s Gastrointestinal Surgery Division
- Specializes in cytoreduction with HIPEC
Dr. Mecker Moller
- University of Chicago Comprehensive Cancer Center, Illinois
- 15+ years of experience
- Director of the HIPEC Program at UCCCC
- Uses both major and minimally invasive treatments
Use our Free Doctor Match to get connected with peritoneal mesothelioma surgeons near you.
Surgery for Other Mesothelioma Types
In very rare cases, mesothelioma tumors can develop in the heart lining (pericardial mesothelioma) or testicle lining (testicular mesothelioma).
Different surgeries may be available to help patients with these uncommon cancers.
Pericardial Mesothelioma Surgery
There are three main surgeries for pericardial mesothelioma:
- Pericardiectomy: This surgery removes tumors and part or all of the pericardium (heart lining).
- Pericardiocentesis: With this palliative surgery, a surgeon uses a small catheter to drain fluid around the heart. This can ease symptoms like chest pain and shortness of breath.
- Tumor resection: Surgeons remove cancerous tumors without removing the pericardium.
Testicular Mesothelioma Surgery
There are two surgeries used to treat testicular mesothelioma:
- Inguinal orchiectomy: Surgeons remove one or both testicles and the spermatic cord (nerves that link the testicles to the abdomen). Most patients recover in 2-3 weeks.
- Lymphadenectomy: This procedure may be used to remove affected lymph nodes if the cancer has spread there. Recovery usually takes 3-6 weeks.
That said, testicular mesothelioma surgeries are rarely used to treat the cancer itself. They are usually only performed when a cancerous tumor is misdiagnosed as a hernia and doctors start to operate, according to the American Cancer Society (ACS).
Extending Survival Rates With Surgery for Mesothelioma
Because mesothelioma surgeries can help patients live longer, they have a positive impact on the overall survival rates for this cancer. Mesothelioma survival rates are used to measure the percentage of patients still alive after a set period of time.
Here is an overview of mesothelioma survival rates after surgery:
- Cytoreduction with HIPEC survival rate: Patients who underwent this treatment and then received follow-up chemotherapy had a 5-year survival rate of 80% in a 2022 Journal of Clinical Haematology study. This means 8 out of 10 patients were still alive 5 years later.
- EPP survival rate: Patients who received this surgery had a 5-year survival rate of 11%, according to a report published by Oncology Letters.
- P/D survival rate: The 5-year survival rate for a P/D is 44%, as noted by the same Oncology Letters report.
When looking at mesothelioma surgery survival rates, it’s important to remember that they are only averages. It may be possible for you to live for many years depending on how your body responds to a successful mesothelioma cancer surgery.
Who Is Eligible for Mesothelioma Surgery?
Typically, only early-stage mesothelioma patients undergo a major mesothelioma surgery. When the cancer is in its early stages, it’s contained in one part of the body, so doctors can remove as much of it as possible via surgery.
By contrast, surgery for mesothelioma won’t be as helpful for late-stage patients as metastasis (cancer spread) has occurred and doctors can’t remove all of it with surgery.
Other eligibility factors for a mesothelioma surgery include:
- Age: Younger patients are often healthier and can recover from mesothelioma surgery faster than older patients.
- Overall health: Patients need to be in good general health to qualify for a major surgery. Other health problems could put the patient at risk of serious complications.
- Treatment goals: Each patient controls their own treatment plan, and some may not feel that a mesothelioma surgery is right for them. In these cases, doctors may be able to recommend other treatments.
Find out if surgery could help you or a loved one by bringing our Free Doctor Questions Checklist to your next appointment.
Preparing for Mesothelioma Surgery
Patients can prepare for mesothelioma surgery by:
- Undergoing a surgical evaluation: This exam helps ensure that a mesothelioma surgery is the best treatment and that a patient is healthy enough to undergo the surgery.
- Having tests run: Patients may need to undergo blood, heart, and lung tests as a precaution before getting surgery. These will evaluate how well the patient’s major organs are functioning to make sure a surgical procedure won’t cause complications.
- Getting imaging scans: Prior to surgery, patients may need to get imaging tests like positron emission tomography (PET) or computed tomography (CT) scans. These scans will help doctors see exactly where the cancer is so all tumors can be removed during surgery.
Mesothelioma Surgery Recovery
Recovering from a major mesothelioma surgery will take time.
Patients must often stay in the hospital for up to 2 weeks after an EPP, P/D, or cytoreduction with HIPEC. After discharge, patients will typically need to recover at home for several more weeks.
Find out how long it takes to recover from each surgery 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 |
During recovery from a mesothelioma surgery, patients may be hooked up to IVs while in the hospital and given pain medications.
Patients should also be aware of complications or side effects after surgery and report any problems to their doctor so they can be quickly addressed.
Mesothelioma surgery side effects may include:
- Bleeding
- Blood clots
- Changes in heart rhythm
- Chest fluid buildup
- Damaged organs
- Infections
- Loss of lung function
- Pain
- Pneumonia
- Respiratory problems
See If You Qualify for Mesothelioma Surgery
If you or a loved one has been recently diagnosed with mesothelioma, surgery may be a key part of your treatment plan.
A mesothelioma surgery could potentially add years to your life, giving you more time to spend with your family and other loved ones.
Mesothelioma Hope has on-staff nurses and Patient Advocates who can connect you with top doctors who can confirm if you’re eligible for surgery and other life-extending treatments.
Call (866) 608-8933 to speak with our team and start the road to healing.
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.
Surgery for Mesothelioma FAQs
Can mesothelioma be removed with surgery?
Yes. Major surgery allows doctors to take out visible mesothelioma tumors.
However, microscopic cancer cells could still be left behind after surgery. To kill these cancer cells, doctors may use other treatments like radiotherapy or chemotherapy before or after surgery.
How long does mesothelioma surgery take?
It depends on the type of surgery you receive. Minor mesothelioma surgeries like a thoracentesis take only 30 minutes, while major ones such as cytoreduction with HIPEC can last up to 12 hours.
Your doctor can provide a specific time frame for how long a mesothelioma surgery will take.
What kind of surgery is done for mesothelioma?
There are three main types of mesothelioma surgeries:
- Cytoreduction with HIPEC: Treats peritoneal mesothelioma by extracting cancer tumors from the abdomen and then bathing it in warm chemotherapy
- Extrapleural pneumonectomy (EPP): Treats pleural mesothelioma by removing the lung, lung lining, and cancer tumors
- Pleurectomy with decortication (P/D): Treats pleural mesothelioma by taking out the lung lining and tumors but sparing the lungs
There are also minor procedures designed to relieve pain and other cancer symptoms, which are known as palliative surgeries.
Which mesothelioma surgeries you can undergo will depend on factors like your overall health, cancer stage, and more.
Can you remove a lung with mesothelioma?
Yes, it’s possible to remove a cancerous lung with mesothelioma through EPP surgery.
A mesothelioma surgeon can determine if removing a lung (or using another lung-sparing surgery) is best for your case.
Contact our Patient Advocates to get help finding doctors near you who perform mesothelioma surgery.
What is the recovery from mesothelioma surgery?
The recovery from mesothelioma surgery can vary depending on factors such as the type of surgery performed, the extent of the cancer, and the patient’s overall health.
Here’s a general overview of what to expect:
- Hospital stay: Patients will typically spend time in the hospital under close medical supervision. The length of the hospital stay can vary but is often several days to a week or more.
- Physical recovery: Depending on the type of mesothelioma surgery performed, patients may experience limitations in mobility and physical activity during the initial recovery period. Physical therapy may be recommended to help regain strength and range of motion.
- Monitoring for complications: Patients will be closely monitored for any signs of complications such as infection, bleeding, or respiratory issues. Follow-up appointments with the surgical team will be scheduled to assess progress and address any concerns.
- Gradual return to normal activities: As recovery progresses, patients can gradually resume their normal activities and daily routines. The timeline for this varies by patient and can take anywhere from days to several weeks.
- Long-term follow-up: Patients will continue to have regular check-ups and imaging scans to make sure any potential issues are discovered as soon as possible.
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