Improving Survival Rates Through Mesothelioma Surgery
When patients are diagnosed with mesothelioma, they require a specialized multimodality treatment plan, which may include surgery. Mesothelioma surgical procedures can help extend a patient’s life and reduce painful symptoms.
During mesothelioma surgery, doctors remove the mesothelioma as best as possible, either fully or partially.
Your doctor will perform specific surgeries depending on your disease:
- Cell type
Video Summary: Registered Nurse Amy Fair discusses mesothelioma surgery options and who may be a candidate. View Transcript.
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.
Surgeries can be risky, especially if the cancer has spread or if you are in poor overall health.
Your doctor will help you determine if you are eligible for surgery, however, all patients are advised to seek a second opinion from a mesothelioma specialist before undergoing surgical treatment of any kind.
Mesothelioma Treatment Goals
A doctor may recommend surgical intervention to accomplish specific mesothelioma treatment goals.
Treatment goals may include:
- Eliminating mesothelioma completely from the chest, abdomen, or heart
- Removing as much of the visible tumors as possible
- Preventing recurrence (when cancer comes back after treatment)
- Improving the quality of life by relieving pressure from the chest, abdomen, or heart
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.
Who Is Eligible for Mesothelioma Surgery?
Not every patient will be eligible to undergo mesothelioma surgery.
Patients who have the following may not be eligible for mesothelioma surgery:
- Advanced age
- General poor health
- Other serious medical conditions (comorbidities)
- Smokers or former smokers
- Heavy drinkers
Provided they meet the right criteria, many patients will be recommended mesothelioma surgery. Surgery-based multimodal treatment typically gives patients the best shot at long-term survival.
- Mesothelioma surgery can have serious risks and side effects, with roughly 1 in 3 patients having major complications during or after surgery.
- According to the American Cancer Society (ACS), a small number of people who have had curative mesothelioma surgery lived long periods of time without cancer.
- Some studies have suggested that mesothelioma surgery that removes a part of the lung is preferable to surgeries that remove an entire lung.
Types of Mesothelioma Surgery
There are two main types of mesothelioma surgery doctors use to treat patients. The surgery chosen largely depends on the cancer’s location, stage, and other factors.
Mesothelioma surgery is usually done for one of two reasons:
- To remove all visible signs of mesothelioma (curative surgery)
- To relieve pain and symptoms (palliative surgery)
Patients who are in otherwise good health may be eligible for potentially curative surgery for mesothelioma. This type of surgery may be an option if the cancer can be completely removed.
Even with curative surgery, cancer cells are oftentimes left behind — even when all of the cancer that can be seen is removed. When this happens, the cancer cells may continue to grow and divide, bringing the cancer back after the mesothelioma surgery.
Many doctors agree that surgery will not cure mesothelioma patients, however, it may help them live longer.
Unfortunately, curative surgery for mesothelioma is not an option for every victim.
Palliative mesothelioma surgery may be an option for patients who have tumors that have already spread to the point at which they would be difficult to remove completely.
The goal of this type of surgery for mesothelioma is to keep the illness under control, keeping the patient well for as long as possible. In other words, this type of surgery for mesothelioma is performed to reduce pain or prevent symptoms, rather than to cure the cancer.
Palliative surgery for mesothelioma may also be an option for patients who are too ill for more complicated surgeries. It may help victims live longer and healthier lives.
Surgery for Pleural Mesothelioma
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 surgery options for pleural mesothelioma below.
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 lung.
In EPP surgery for mesothelioma, the patient’s lung is removed on the side of the cancer. Additionally, the pleura, diaphragm, and nearby lymph nodes are removed. 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 removed. However, there may be significant drawbacks.
EPP drawbacks include:
- 5-10% of patients die during or shortly after this type of 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 2 weeks after the mesothelioma surgery.
- The recovery period may be 3-4 months long.
Some of the complications that may occur include:
- Blood clots
- Wound infections
- Changes in heart rhythm
- Fluid build-up in the chest
- Loss of lung function
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.
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 may be performed as a potentially curative mesothelioma surgery, but it can also be used for palliative measures to relieve symptoms.
Patients who undergo P/D surgery for mesothelioma will likely need to stay in the hospital for about a week after the surgery. Recovery time can be 4-6 weeks.
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.
The aim of partial pleurectomy surgery for mesothelioma is to remove as much of the cancer as possible. In this type of surgery, less tissue is usually removed.
While a partial pleurectomy may treat symptoms, it is not a curative surgery for mesothelioma and unfortunately does not typically improve the chances of survival.
Pleural mesothelioma patients who are eligible to undergo surgery may be able to access financial compensation to help them afford treatment.
Top Pleural Mesothelioma Surgeons
Pleural mesothelioma surgery is not performed routinely. This kind of surgery for mesothelioma is complex and only done in large medical centers by experienced surgeons.
Below, learn more about several notable doctors who perform surgery for mesothelioma.
Dr. Abraham Lebanthal
Dr. Abraham “Avi” Lebanthal 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. Lebanthal is the Director of Minimally Invasive Thoracic Surgery at the VA Boston Healthcare System-West Roxbury, helping veterans who have been diagnosed with mesothelioma. Dr. Lebanthal is 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 Michael Flores
Dr. Raja Flores is the Chairman for the Department of Thoracic Surgery at The Mt. 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 implemented the Memorial Sloan-Kettering Cancer Center’s current program.
Mesothelioma Hope has no affiliation with and is not endorsed or sponsored by Dr. Robert B. Cameron. The contact information above is listed for informational purposes only. You have the right to contact Dr. Cameron directly.
Surgery for Peritoneal Mesothelioma
The second most common type of mesothelioma, peritoneal mesothelioma, forms in the lining of the abdomen and has the best prognosis.
Surgical options for mesothelioma of the peritoneum are performed to remove the tumor or to ease symptoms.
There are different types of surgery that can be performed for peritoneal mesothelioma, but the most common operation is a two-part procedure called cytoreduction with HIPEC.
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, gall bladder, liver, pancreas, spleen, and stomach.
This procedure has worked well for some mesothelioma patients, with half surviving five years after surgery.
Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Before cytoreductive surgery for mesothelioma is completed, surgeons may put chemotherapy into the abdomen after the cancer is removed to kill remaining cancer cells. Once the chemotherapy is put in, the surgical incision is closed.
Some studies have shown chemotherapy works better if it is circulated throughout the abdominal cavity and heated, a process called hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC).
Cancers in the peritoneum often spread to the omentum, a layer of fatty tissue covering the abdominal organs.
When this occurs, the omentum may also be removed during debulking surgery for mesothelioma. This procedure is called an omentectomy.
Top Peritoneal Mesothelioma Surgeons
Curative surgery for mesothelioma is incredibly complex and specific, often taking years of consistent practice to perfect. Mesothelioma doctors, especially surgeons, usually specialize in a specific type of mesothelioma.
Dr. Paul Sugarbaker
Dr. Paul Sugarbaker is a world-renowned expert on peritoneal mesothelioma. He is credited with developing, perfecting, and popularizing the combination of mesothelioma surgery with heated chemotherapy. Dr. Sugarbaker is Chief of the Washington Hospital Peritoneal Surface Malignancy Program in Washington, D.C. He is also Director of the Center for Gastrointestinal Malignancies.
Dr. James F. Pingpank Jr.
Dr. James Pingpank is an Associate Professor of Surgery at the University of Pittsburgh. An expert in gastrointestinal cancers, Dr. Pingpank specializes in cytoreductive surgery and HIPEC.
Dr. W. Charles Conway
Dr. Charles Conway is a surgical oncologist at Ridley-Tree Cancer Center at Sansum Clinic in Santa Barbara. While many oncologists specialize in pleural mesothelioma surgery, Dr. Conway is one of a limited number of surgeons with experience with surgery in the rarer form of peritoneal mesothelioma.
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 of mesothelioma that affects the lining of the heart (pericardium). It makes up only 1% of all cases and has the lowest life expectancy of only 6 months to 1 year after diagnosis.
Mesothelioma surgery options for this type include a pericardiectomy, which involves removing the entire pericardium, easing pressure on the heart.
Another surgery option involves making a hole in the pericardium, which can be used to put chemotherapy into the heart area.
Testicular Mesothelioma Surgery
Mesothelioma surgery for the testicles is rarely done in an effort to cure the cancer. Rather, it is mostly only done when a cancerous tumor is mistaken for a hernia.
In most cases, only after the surgeon tries to remove the hernia is it discovered to be a cancerous tumor. This type of mesothelioma can almost never be removed entirely.
Understanding the different surgery options for mesothelioma may seem overwhelming, but numerous resources exist to provide information and guidance.
Palliative Surgery for Mesothelioma
Mesothelioma is hard to destroy completely, making potentially curative surgery for mesothelioma a less commonly recommended treatment option.
However, palliative surgery may be recommended to help ease the symptoms the cancer is causing or to control the cancer from spreading.
Below, learn more about types of palliative surgery for mesothelioma.
Catheter placement is an approach used to control the buildup of fluids.
During this procedure, a catheter, which is a thin and flexible tube, is inserted into the chest or abdomen, depending on where the mesothelioma is located.
The other end of the catheter remains on the outside of the body and can be used to regularly drain fluids, even at home.
Paracentesis is a procedure performed in mesothelioma patients experiencing fluid buildup.
During paracentesis, a thin, hollow needle is put through the skin into the belly, and fluid is removed. The procedure can be done at the hospital or at a doctor’s office.
Since the fluid is likely to build up again, paracentesis may need to be repeated.
Like paracentesis, thoracentesis is a procedure performed in mesothelioma patients with fluid buildup. However, during thoracentesis, the needle is inserted into the chest to remove fluid from this area.
In this case, if the fluid keeps on coming back, a catheter can be inserted to allow easier drainage of fluid on a regular being.
Pericardiocentesis is another procedure performed to remove fluid. During this procedure, fluid is removed from the sac around the heart.
If fluid is building up in the chest of a mesothelioma patient, pleurodesis may be done. In pleurodesis, a small cut is made in the chest wall, and a chest tube is inserted to drain fluid out.
Chemotherapy or other drugs are put into the tube to force the linings of the lung to stick to itself and to obliterate the pleural space so that the fluid cannot gather there. This may prevent further fluid buildup.
The chest tube is usually left in for 1 or 2 days to drain any new fluids.
A shunt is a flexible, thin, and long tube that has a small pump in its middle. Shunts are used to let fluids move from one part of the body to another.
Shunt surgery for mesothelioma is when one end of the tube is inserted into the part of the body where there is fluid buildup. The other end is put into a different location where the body is more likely to absorb it.
An example is a pleuro-peritoneal shunt, which allows excess fluid in the chest to drain into the belly.
Once the shunt is in place, the patient pumps it several times per day by pushing down on the pump.
Risks and Side Effects of Surgery for Mesothelioma
Surgery for mesothelioma can come with very serious risks and side effects.
The biggest factor that comes into play when deciding on the best mesothelioma surgery option is the general health of the patient. An extensive evaluation must be performed since surgery can be especially dangerous for some patients.
Certain tests will be done to make sure the patient is healthy enough to not only have the mesothelioma surgery but also to recover from it.
These evaluations may include:
- Pulmonary function tests: These tests determine how well the patient’s lungs are working. Testing will tell the health care team whether the patient’s other lung will keep working if one lung is removed. If the lungs are not healthy, surgery may not be an option.
- Heart function tests: These are done to make sure the heart is healthy enough to withstand surgery. Problems can happen during surgery, such as irregular heartbeat or heart attack. The two most common heart function tests to be performed before mesothelioma surgery are an electrocardiogram (ECG) and an echocardiogram.
- Blood chemistry tests: Blood tests will be done to see how well the patient’s liver and kidneys are working.
Even if a patient is able to and undergoes surgery for mesothelioma, it is not uncommon for them to experience some complications.
Common mesothelioma surgery complications include:
- Blood clots
- Changes in heart rhythm
- Chest fluid build-up
- Damaged organs
- Lung function loss
- Respiratory problems
While mesothelioma surgery may pose a risk to a patient’s life, doctors try to determine which patients are most at risk before conducting surgery.
Recovery After Mesothelioma Surgery
Recovering after surgery for mesothelioma is likely to be a lengthy and exhausting process.
Upon waking from surgery, many patients report feeling confused and disoriented, and painkillers and anesthetics often make patients drowsy.
Recovery for mesothelioma surgery is generally between 4-8 weeks and can last as long as a year. You may need to remain in the hospital for up to 2 weeks following your surgery.
After mesothelioma surgery, oxygen levels are monitored, with some patients needing to use an oxygen mask. Depending on how advanced the mesothelioma was, patients may first be moved to an Intensive Care Unit (ICU).
While each person will have a different path to recovery, mesothelioma patients can typically expect to be connected to various tubes and drains after surgery.
The tubes and drains may include:
- An intravenous drip for liquids
- A tube down the nose into the stomach
- Drains coming out of the surgical wound
- A tube (catheter) into the bladder to collect and measure urine
- A tube into the back (epidural) for painkillers
After surgery, mesothelioma patients may also expect:
- Wounds with stitches or clips with dressings covering them
- Painkillers to control pain
- Exercises to move them around, lessening chances of infections or blood clots
- Home recovery with assistance for several weeks or months
- Follow-up appointments
- Additional treatment, such as chemotherapy or radiotherapy
Those who undergo mesothelioma surgery will often see progress being made after a few days, with many patients going home after about 1-2 weeks in the hospital.
The Mesothelioma Hope team knows that surgery for mesothelioma is a complicated decision that can feel overwhelming. For this reason, we’ve helped hundreds of mesothelioma victims navigate this devastating diagnosis.
Contact us today to discuss how we can help mesothelioma patients and their families navigate care.