- 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.
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 in conjunction with other treatments.
It’s critical for patients to 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 quality of life by relieving pressure from the chest, abdomen, or heart (palliative surgery)
- Preventing recurrence (when cancer comes back after treatment)
- Removing as much 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.
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.
Who Is Eligible for Mesothelioma Surgery?
Not every patient is able to undergo mesothelioma surgery, but there are patients who 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 undergoing any kind of surgery.
Mesothelioma patients eligible for surgery may be able to access financial compensation to help them afford treatment.
Preparing for Mesothelioma Surgery
When determining the best mesothelioma surgery option for a patient, the most important factors are the patient’s pulmonary and cardiovascular health. An extensive evaluation must be performed because surgery can be dangerous for some mesothelioma patients.
Doctors will run tests to make sure the patient is healthy enough to not only undergo the mesothelioma surgery but also to recover from it.
These evaluations may include:
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
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.
The average life expectancy for pleural mesothelioma patients is less than 18 months.
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
The following potentially curative surgeries may be an option for pleural mesothelioma patients if the cancer can be completely removed.
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, as well as improve their quality of life.
Extrapleural Pneumonectomy (EPP)
Some patients may be eligible for extrapleural pneumonectomy (EPP) surgery for mesothelioma.
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 their 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.
P/D 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.
Mesothelioma patients who undergo P/D surgery will likely need to stay in the hospital for about a week after surgery. Total recovery time can range from 4-6 weeks.
P/D With HITHOC
Similar to 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), which can lead 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 have the potential 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, 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 continues to build up in the chest, pleurodesis may need to be repeated more than once to control symptoms.
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Thoracentesis
Thoracentesis is a surgical procedure performed in mesothelioma patients with fluid buildup. During 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 for up to 72 hours after the procedure.
If the fluid returns later on, a catheter can be inserted to allow easier drainage of fluid 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 having to undergo multiple thoracentesis surgeries.
Top Pleural Mesothelioma Surgeons
Dr. Abraham Lebenthal
Dr. Abraham “Avi” Lebenthal is a thoracic surgeon who performs mesothelioma surgery at Brigham and Women’s Hospital in Boston. Brigham and Women’s is the home of the International Mesothelioma Program (IMP), one of the largest programs for mesothelioma in the world.
In addition, Dr. Lebenthal is the Director of Minimally Invasive Thoracic Surgery at the VA Boston Healthcare System-West Roxbury, helping veterans who have been diagnosed with mesothelioma. He is also an instructor in surgery at Harvard Medical School.
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. UCLA’s Comprehensive Mesothelioma Program has been using lung-sparing surgery since 1997, stressing patient survival and quality of life.
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 a type of video-assisted surgery as the gold standard in the surgical treatment of 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 the use of 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. Dr. Ripley was chosen by renowned mesothelioma specialist Dr. David Sugarbaker to be 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). The heated chemotherapy fluid bathes the surfaces where cancer cells may have remained after the mesothelioma tumors were removed.
Once the chemotherapy is put in, the surgical incision is closed. Patients who undergo cytoreduction surgery with HIPEC can expect to spend an average of 2-3 months recovering
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 for 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 buildup. Paracentesis is sometimes called an abdominal tap or an ascitic tap.
The surgery provides temporary relief from peritoneal effusion. Doctors may repeat the procedure as needed to manage the patient’s symptoms. In some cases, doctors may recommend leaving a catheter in the peritoneal cavity to drain as needed.
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 person 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.
Surgery for Other Mesothelioma Types
Surgery for mesothelioma cancer is not limited to the most common types of this disease. Patients with other types may also be candidates for mesothelioma surgery.
Pericardial Mesothelioma Surgery
Pericardial mesothelioma is a rare form of mesothelioma that affects the lining of the heart (pericardium). It makes up only 1% of all cases and has the lowest life expectancy — only 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 form of the disease that causes cancerous tumors to form in the protective lining that covers 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, a surgery to remove one or both testicles along with 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 a few months after their mesothelioma surgery.
It’s important for patients to 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.
Recovery from mesothelioma surgery is generally between 4-8 weeks. You may need to remain in the hospital for up to 2 weeks following your surgery, depending on the procedure.
After an invasive mesothelioma surgery, oxygen levels are monitored, with some patients needing an oxygen mask.
Each person will have a different path to recovery, but 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
- Home recovery with assistance for several weeks or months
- 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
Those who undergo mesothelioma surgery will often see progress after a few days, with many patients going home after about 1-2 weeks in the hospital.
The Mesothelioma Hope team understands that mesothelioma surgery is a complicated decision that can feel overwhelming. That’s why we’re dedicated to helping hundreds of mesothelioma victims navigate their diagnosis and find the best possible treatment.
Contact us today to discuss how we can help mesothelioma patients and their families determine whether surgery is right for them.
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.
In some cases, these cancer cells may end up growing and dividing, 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 as long as 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 increments of 1, 2, and 5 years. 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 the type of mesothelioma can all affect an individual’s survival rate. Additionally, patients who do not receive mesothelioma treatment have a lower chance of surviving mesothelioma.
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.
