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Pleural Mesothelioma Surgery

Pleural mesothelioma surgery is an effective option for patients who want to improve their prognosis and quality of life. There are various types of pleural mesothelioma surgeries, and which one(s) can be used depends on your health, treatment goals, and cancer stage. If you’re considering surgery for pleural mesothelioma, our nurses and Patient Advocates can help you find the best doctors in your area for treatment.

Fact-Checked and Updated by: Jenna Tozzi, RN

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What Are the Goals of Pleural Mesothelioma Surgery?

Surgery plays a key role in treatment plans for patients with pleural mesothelioma, a rare cancer that affects the lung lining (pleura).

Pleural mesothelioma surgery has two goals:

  1. Extend life expectancy: Removing cancerous tumors and tissue can prevent mesothelioma from spreading and help patients live longer.
  2. Manage symptoms: By relieving pressure on surrounding organs and tissues, pleural mesothelioma surgery can help reduce symptoms like difficulty breathing, chest pain, and coughing.
Average Life Expectancy With Treatment
  • Surgery & Chemotherapy: 21.7 months
  • Chemotherapy Alone: 11.4 months
Source: NCDB

Surgery for pleural mesothelioma can also make other treatments such as chemotherapy and immunotherapy more effective.

A 2022 review of the National Cancer Database (NCDB) found that patients who had pleural mesothelioma surgery and chemotherapy lived nearly twice as long as those who received chemotherapy alone.

Mesothelioma surgery performed with the goal of increasing survival is known as curative surgery. Surgery that is used to manage symptoms and improve quality of life is called palliative surgery. Patients may be able to get one or both types of surgery.

Key Facts on Surgery for Pleural Mesothelioma

  • Curative surgeries: Pleurectomy with decortication (P/D), extrapleural pneumonectomy (EPP)
  • Palliative surgeries: Pleurodesis, cytoreductive surgery, thoracentesis
  • Complementary treatments: Chemotherapy, immunotherapy, radiation therapy, clinical trials
  • Life expectancy after treatment: 21 to 38 months or more

Mesothelioma Hope can help you connect with top doctors with experience performing pleural mesothelioma surgery. Sign up for our Free Doctor Match service to get started.

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Who’s Eligible for Pleural Mesothelioma Surgery?

There isn’t a one-size-fits all approach to surgery, and patient eligibility is determined on an individual basis.

However, most mesothelioma doctors will consider these factors:

  • Current health status: Surgery is more likely to be an option if you’re in good overall health with no serious co-occurring conditions.
  • Lung function: Major pleural mesothelioma surgery involves removing the pleura (lung lining) and sometimes the lung nearest to the cancer tumors. Doctors will run tests to make sure your respiratory function won’t be compromised if you get one of these surgeries.
  • Mesothelioma stage: You’re more likely to be cleared for surgery if you’re in the early stages of mesothelioma (stages 1 and 2) vs. the more advanced stages (stages 3 and 4) tumors have spread to the lymph nodes or other organs.
  • Response to other treatments: Your doctor will assess your experience with prior treatments, if any. In certain situations, surgery may only be recommended after another mesothelioma treatment has failed or stopped working.

Everyone’s situation is different, so you should talk to a pleural mesothelioma specialist to determine the best treatment for your case. Call us at (866) 608-8933 for help finding a doctor near you.

Curative Surgery for Malignant Pleural Mesothelioma

There are two types of curative surgery for pleural mesothelioma cancer: pleurectomy with decortication and extrapleural pneumonectomy.

Breakdowns of both surgeries are provided below.

Pleurectomy With Decortication

Pleurectomy with decortication (P/D) removes part of the lung lining along with visible tumors and affected tissue.

The procedure generally follows these steps:

  1. A thoracic surgeon makes an incision (cut) along the chest wall to access the pleural cavity.
  2. The pleura is carefully peeled away from the chest wall, allowing the surgeon to see where the patient’s tumors are located.
  3. Visible tumors are removed from the pleura while sparing the underlying lung.
  4. Cancerous tissue may be scraped off the outer layer of the lung if necessary.
  5. The surgery site is closed, and the chest cavity is sealed to minimize the risk of air leaks.

Extrapleural Pneumonectomy

Extrapleural pneumonectomy (EPP) is an aggressive surgical procedure that removes the entire cancerous lung, the pleura, portions of the diaphragm (the muscle below the lungs), and the pericardium (heart lining).

Here’s how the procedure generally goes:

  1. A large incision is made on the side of the chest, providing access to the pleural cavity.
  2. The affected lung is carefully dissected and removed, along with the pleura.
  3. Portions of the diaphragm and pericardium may be removed if cancer has spread into them.
  4. The diaphragm and pericardium are reconstructed using synthetic materials or grafts.
  5. The incision is closed, and the chest cavity is sealed.

Some doctors prefer to use an EPP over a P/D because it allows more cancer to be removed. However, an EPP may come with a higher risk of complications since an entire lung is removed. Consult a doctor to find out if an EPP or P/D may be better in your case.

We can help you find mesothelioma surgeons with experience in P/D and EPP — try our Free Doctor Match now.

Mesothelioma doctor talking with an older couple
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Pleural Mesothelioma Life Expectancy With Surgery

A patient discusses pleural mesothelioma surgery with his doctor

Surgery for pleural mesothelioma can significantly improve your life expectancy, especially in combination with chemotherapy and other treatments.

Pleural mesothelioma patients who had EPP surgery with heated chemotherapy (HITHOC) lived 38.1 months on average, according to data published in Translational Lung Cancer Research.

Another study published in the Journal of Thoracic Disease found that patients who underwent P/D surgery lived for 34 months on average.

In comparison, the average pleural mesothelioma life expectancy without treatment is 4 to 12 months.

Palliative Surgery for Pleural Mesothelioma

Palliative surgery can enhance your quality of life by reducing uncomfortable pleural mesothelioma symptoms and improving your lung function.

Here are some common palliative surgeries for pleural mesothelioma:

  • Cytoreductive surgery (also called debulking surgery) can be performed to remove as much of the tumor as possible, which can ease pressure on surrounding organs and alleviate symptoms like coughing and chest pain.
  • Pleurodesis involves permanently sealing the layers of the pleura to prevent the buildup of extra fluid (pleural effusion), a common symptom of pleural mesothelioma that causes chest pain and shortness of breath.
  • Thoracentesis is a procedure where a doctor removes excess fluid from the pleural space using a needle. It helps relieve symptoms associated with pleural effusion, helping make patients feel more comfortable.

You can learn more about palliative treatments for pleural mesothelioma by speaking with our in-house registered nurse. Fill out our contact form to get connected.

The Role of Surgery in Multimodal Treatment

Surgery for pleural mesothelioma is often combined with other treatments as part of multimodal therapy.

Here’s how pleural mesothelioma surgery works with other treatments:

  • Chemotherapy: Administering chemotherapy before surgery can help shrink tumors and make them easier to remove during surgery. Chemotherapy can also be used after surgery to kill remaining cancer cells that were left behind and minimize the risk of the patient’s cancer returning.
  • Radiation therapy: Radiation can be used to help reduce tumor size before pleural mesothelioma surgery. After surgery, radiation therapy can be used to damage the DNA of cancer cells, preventing them from spreading.
  • Immunotherapy: Immunotherapy drugs can help stimulate the body’s natural defense system to recognize and attack cancer cells before and after surgery.
  • Clinical trials: There are various clinical trials testing pleural mesothelioma surgeries in combination with existing and emerging treatments.
Did You Know?

A clinical trial led in part by pleural mesothelioma specialist Dr. Taylor Ripley at Baylor College of Medicine found that pre-surgery immunotherapy improved patient survival. All the patients studied were still alive more than 3 years after treatment.

Pleural Mesothelioma Surgery Recovery & Side Effects

A pleural mesothelioma doctor reviews a patient's chest X-rays

Once the surgery is complete, you’ll need to spend up to 2 weeks in the hospital before returning home to continue your recovery.

Keep reading to learn more about the recovery process and potential side effects after surgery for pleural mesothelioma.

P/D Recovery and Side Effects

After a P/D, you will need to stay in the hospital for a few days so staff can monitor your vital signs and manage any pain you have.

Once stable, you’ll be discharged to continue recovery at home. Full recovery from P/D surgery may take several weeks to months, with gradual improvement in your physical strength and overall well-being.

Possible side effects of P/D surgery include:

  • Air leaks
  • Changes in lung function
  • Chest pain and soreness

Your doctor will continue to monitor you for potential long-term complications and address any emerging issues during regular follow-up appointments.

EPP Recovery and Side Effects

If you undergo an EPP, you’ll receive intensive care immediately after surgery because of the more extensive nature of the procedure. You may also need to remain at the hospital for a week or longer so medical staff can monitor your recovery.

Physical therapy and rehabilitation services may be introduced to help you adapt to life with one lung. Once you’re cleared for discharge, you will continue your recovery from home, where you may be asked to do breathing exercises to speed up the healing process.

EPP side effects can be more severe than those from P/D , and may include:

  • Blood clots
  • Internal bleeding
  • Pneumonia

Just like with P/D surgery, you’ll need to attend regular follow-up appointments to ensure you make a successful recovery.

Need help finding a top surgeon? Use our Free Doctor Match to let one of our Patient Advocates help you find and schedule appointments with local specialists.

Mesothelioma doctor talking with an older couple
Free Mesothelioma Doctor Match

We'll help you connect with a local mesothelioma specialist for personalized treatment.

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How Much Does Surgery for Pleural Mesothelioma Cost?

The cost of pleural mesothelioma surgery can vary based on the type of surgery, your insurance coverage, and other factors.

Average Costs for Surgery & Chemotherapy
  • Surgery: Up to $62,480
  • Chemotherapy: Up to $38,779
Source: Rare Tumors

However, there are options that can help you pay for surgery and treatment-related expenses:

  • Asbestos trust fund claims: More than $30 billion is already set aside in trust funds established by asbestos manufacturers to compensate current and future mesothelioma patients.
  • Mesothelioma lawsuits: You may be able to file a lawsuit against asbestos manufacturers that haven’t already set up trust funds. The average settlement from a mesothelioma lawsuit awards $1.1 million to $1.4 million.
  • Veterans benefits: Married veterans who developed pleural mesothelioma from asbestos exposure during military service may qualify for disability benefits totaling nearly $4,000 a month.

Compensation from these sources can be used for anything you see fit, including the costs of pleural mesothelioma surgery and other treatments.

Explore Pleural Mesothelioma Surgery & Other Treatment Options

Our dedicated team is here to help you find the right doctor for pleural mesothelioma surgery and pursue compensation to make your treatment journey more manageable.

You don’t have to face a mesothelioma diagnosis alone — let us be a source of hope and guidance for you or a loved one.

Get help right now by calling (866) 608-8933 or using our Free Doctor Match service.

Pleural Mesothelioma Surgery FAQs

Can mesothelioma be surgically removed?

Yes, mesothelioma tumors can be removed with surgery in patients who are healthy enough.

The two main tumor-removing surgeries for pleural mesothelioma are pleurectomy with decortication (P/D) and extrapleural pneumonectomy (EPP).

The choice of surgery depends on various factors, including the stage of the cancer and the patient’s overall health.

What is the surgery for cancer in the pleura?

Pleurectomy with decortication (P/D) is the most common surgery for cancer that develops in the lung lining (pleura).

During a P/D, the surgeon removes tumors from the pleura with the goal of managing mesothelioma symptoms, improving the patient’s quality of life, and possibly extending survival.

Unlike an extrapleural pneumonectomy (EPP), a P/D doesn’t require the entire affected lung to be taken out. Instead, the goal is to remove as much cancerous tissue as possible while preserving the patient’s lung function.

Does surgery increase life expectancy in pleural mesothelioma?

Yes, surgery can increase pleural mesothelioma life expectancy depending on factors such as the stage of the cancer, the patient’s overall health, and how successful the procedure is.

In some cases, pleural mesothelioma surgery has allowed patients to become long-term survivors. One such survivor is John Panza, who’s still living a full life 12+ years after his diagnosis thanks to EPP surgery, radiation, and chemotherapy.

How long does pleural mesothelioma surgery take?

The time required for pleural mesothelioma surgery varies depending on the type of surgery and the complexity of the case.

A P/D generally takes a few hours, while an EPP may take several hours since the patient’s entire affected lung is removed, along with the pleura and parts of the diaphragm and heart lining.

Can you cure pleural mesothelioma with surgery?

While surgery is an integral part of multimodal treatment for pleural mesothelioma, it’s challenging to completely cure this disease because of how aggressively it spreads.

However, pleural mesothelioma surgery has helped many patients live longer by removing cancerous tumors. Surgery can also make patients more comfortable by helping them manage symptoms like chest pain and shortness of breath.

What is the success rate for pleural mesothelioma surgery?

The success rate of surgery for pleural mesothelioma varies based on factors such as the stage of the disease, the patient’s overall health, and the type of surgery performed.

Medical literature shows that surgery leads to higher survival rates, especially in combination with other treatments like chemotherapy.

Specifically, 21% of EPP patients and 60.9% of P/D patients are still alive at 2 years with treatment, according to studies published in peer-reviewed medical journals.

Jenna TozziWritten by:

Director of Patient Advocacy

Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

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References
  1. American Cancer Society. (2023, March 2). Survival Rates for Malignant Mesothelioma. Retrieved January 24, 2024, from https://www.cancer.org/cancer/types/malignant-mesothelioma/detection-diagnosis-staging/survival-statistics.html
  2. Baylor College of Medicine. (2022, December 13). Preoperative immunotherapy for mesothelioma shows favorable outcomes. Retrieved January 24, 2024, from https://www.bcm.edu/news/preoperative-immunotherapy-for-mesothelioma-shows-favorable-outcomes
  3. Bou-Samra, P., et al. (2023). Epidemiological, therapeutic, and survival trends in malignant pleural mesothelioma: A review of the National Cancer Database. Cancer medicine, 12(11), 12208–12220. Retrieved January 24, 2024, from https://doi.org/10.1002/cam4.5915
  4. Breda, C., et al. (2021). Long-term outcomes after lung-sparing surgery for epithelial mesothelioma. Journal of thoracic disease, 13(11), 6283–6293. Retrieved January 24, 2024, from https://doi.org/10.21037/jtd-21-691
  5. Cleveland Clinic. (2022, September 20). Thoracic Surgery. Retrieved January 24, 2024, from https://my.clevelandclinic.org/health/treatments/24201-thoracic-surgery
  6. Cleveland Clinic. (n.d.) Pleural Mesothelioma. Retrieved January 24, 2024, from https://my.clevelandclinic.org/health/diseases/15044-pleural-mesothelioma
  7. Davis, A., Ke, H., Kao, S., & Pavlakis, N. (2022). An Update on Emerging Therapeutic Options for Malignant Pleural Mesothelioma. Lung Cancer (Auckland, N.Z.), 13, 1–12. Retrieved January 24, 2024, from https://doi.org/10.2147/LCTT.S288535
  8. Klotz, L. V., et al. (2022). Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach. Translational lung cancer research, 11(11), 2230–2242. Retrieved January 24, 2024, from https://doi.org/10.21037/tlcr-22-199
  9. Mayo Clinic. (2022, October 19). Mesothelioma Diagnosis. Retrieved January 24, 2024, from https://www.mayoclinic.org/diseases-conditions/mesothelioma/diagnosis-treatment/drc-20375028
  10. Mayo Clinic. (2023, June 6). Palliative Care. Retrieved January 24, 2024, from https://www.mayoclinic.org/tests-procedures/palliative-care/about/pac-20384637
  11. National Cancer Institute. (2023, March 9). Lung-Sparing Surgery Is Effective for Some with Early-Stage Lung Cancer. Retrieved January 24, 2024, from https://www.cancer.gov/news-events/cancer-currents-blog/2023/early-stage-lung-cancer-sublobar-surgery
  12. Sugarbaker, D. J., et al. (1999). Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. The Journal of thoracic and cardiovascular surgery, 117(1), 54–65.  Retrieved January 24, 2024, from https://doi.org/10.1016/s0022-5223(99)70469-1
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