5 Things to Know About Mesothelioma Lung Removal Surgery

Malignant pleural mesothelioma develops in the lining around the lung (the pleura). It is not a type of lung cancer. But some patients may still undergo a type of surgery that includes removing the lung on the affected side.

This type of surgery is known as an extrapleural pneumonectomy (EPP). It removes the pleura, the lung, the diaphragm and the lining around the heart (the pericardium).

As with most cancers, mesothelioma may spread — or metastasize — beyond its starting point. So removing nearby organs and tissues helps decrease the number of cancer cells left behind after surgery.

Patients and loved ones may hear about lung removal surgery (EPP) and think it is the best chance for a cure. But a few lung removal facts may surprise them and change their minds.

1: Lung Removal Surgery Has Serious Risks

It may come as no surprise that surgically removing a lung carries significant risks. In one study, 50% of patients experienced at least one adverse effect from the procedure. Common complications of lung removal via EPP include:

  • Abnormal heartbeats
  • Blood clots
  • Infection

Though it occurs less often, patients can die from the side effects of EPP. According to research, the risk of death differs between hospitals with more or less experience. Centers that do fewer than 5 EPP lung removals per year have a higher risk. In one study, more than 1 out of 10 patients at lower volume centers died from EPP complications. The risk was half that for higher volume hospitals.

2: Lung Removal Surgery Has Become a Last Resort

In the past, lung removal by EPP was strictly reserved for a select group of patients. In general, they had to be in good health with limited tumors to qualify. Over the years, mesothelioma research changed this approach.

According to studies, EPP carries more risk than other pleural mesothelioma surgery options. As a result, many cancer centers have largely abandoned EPP. Doctors may make an exception for patients with tumors extending into the lung. In these cases, surgeons may perform EPP because the tumors cannot otherwise be removed.

Modern medical advances have improved the surgical options for pleural mesothelioma. Many patients qualify for these newer approaches. This means EPP lung removal surgery is an option only for patients with specific, advanced tumors.

3: Recovery After Lung Removal Can Be Difficult and Lengthy

EPP lung removal surgery is an extensive and serious operation. Healthcare providers monitor patients in the hospital for 1 – 2 weeks after surgery. During this time, patients do important breathing and coughing exercises. These actions help keep the remaining lung clear and working.

Once patients go home, the recovery process continues. It may take 3 months or longer to return to work. Some patients may find they cannot go back to the type of work they did before. And recuperation may vary depending on any additional treatments the patient undergoes.

Patients may experience other long-term impacts from this surgery, like difficulty floating in water. Depending on a patient’s lifestyle, these effects could be disruptive or frustrating. Patients may not understand the full scope of these changes until after the surgery.

Survivor Heather Von St. James is a great example of the long-term effects of lung removal. She had a heated chemo treatment after her surgery. This treatment is often paired with an EPP surgery. It temporarily damaged her kidneys and extended her hospital stay. At the time, Heather thought she would go back to work as a hairdresser within a few months. But in the 18 years since she hasn’t returned to it full-time.

4: Lung Removal Surgery Can Limit Later Treatment Options

EPP lung removal surgery fundamentally changes a person’s body. It leaves patients with decreased cardiovascular function. This affects their ability to manage post-surgery conditions like pneumonia. Losing a lung also makes it hard for some patients to handle chemotherapy.

In one study, only 25% of lung removal patients could tolerate chemo after their surgeries. This number rose to more than 60% for those who had a less risky operation. Chemotherapy is a common treatment for patients whose cancer returns or doesn’t respond to other therapies. So taking this option away could negatively impact mesothelioma prognosis.

The popularity of EPP lung removal surgery had already declined before immunotherapies became an option. As such, it is unclear if lung removal affects a person’s eligibility for these innovative drugs. Either way, data indicates lung removal can take chemotherapy off the table. That may be reason enough for some patients to favor less aggressive treatments.

5: Less Risky Treatments Offer Better Outcomes Than Lung Removal

A couple of surgery options carry less risk than EPP lung removal. For eligible patients, they may also improve survival compared to EPP.

Pleurectomy/Decortication (P/D)

P/D is a type of lung-sparing surgery. It removes the lining around the lung but leaves the lung in place. P/D also leaves the diaphragm and lining around the heart.

Extended Pleurectomy/Decortication (eP/D)

eP/D is a type of lung-sparing surgery that goes a step further than P/D. It removes the lining around the lung, and any cancerous areas of the lining around the heart and the diaphragm.

Researchers compared P/D, eP/D and EPP lung removal in a large analysis of multiple studies. They found EPP had double the risk of death and complications. Other studies have compared life expectancy between EPP and P/D.

The results have been mixed. But more research favors P/D than EPP. For example, a recent study looked at combination treatments featuring either EPP or eP/D. Median survivals for the two groups showed a clear difference:

  • eP/D patients: 38 months
  • EPP patients: 24 months

In this study, the less risky surgery resulted in significantly better survival. Other studies have reported similar findings.

What Does This Mean for Mesothelioma Patients?

When people first hear the idea, they may think lung removal surgery seems like the best way to treat pleural mesothelioma. But the facts and research tell a different story. EPP lung removal surgery has become rare because of its many serious risks. And patients have gentler, more promising options these days.

For those with operable tumors, research points to P/D and eP/D as better options. And leaving the lung in place preserves some resilience patients may need later.

So, can lung removal treat pleural mesothelioma? Yes. But for most patients, data indicates it really isn’t the best option.