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Mesothelioma Surgery

Expert Fact Checked

This page was medically reviewed by James Stevenson, M.D. on March 10, 2019. For information on our content creation and review process read our editorial guidelines. If you notice an error or have comments or questions on our content please contact us.

James Stevenson, M.D. Thoracic Medical Oncologist

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Surgery is a common treatment option for mesothelioma. Doctors may perform surgery to diagnose cancer, remove malignant tissue or relieve patient symptoms. Surgery for mesothelioma is often part of a multimodal treatment plan. It may be used with chemotherapy and/or radiation therapy.


01. Types of Mesothelioma Surgery

What Are the Types of Surgery Available for Mesothelioma?

There are many types of mesothelioma surgeries. These options differ based on the goal of the procedure and mesothelioma location. There are three reasons a mesothelioma patient may undergo surgery: diagnosis, removal of tumors and cancerous tissues, and symptom management.

Diagnostic Surgery for Mesothelioma

Doctors may recommend a biopsy to diagnose malignant mesothelioma. A biopsy is the removal of a fluid or tissue sample for analysis. It is the only way to definitively confirm a diagnosis of mesothelioma.

Biopsies can be minimally invasive. However, some are considered open surgical procedures because the impacted tissue or fluid may be more difficult to reach.

  • Thoracoscopy: A minimally invasive biopsy used to diagnose pleural mesothelioma. A doctor makes small incisions between the chest and ribs to remove a tissue sample from the pleural or thoracic cavity.
  • Laparoscopy: A minimally invasive biopsy commonly used to diagnose peritoneal mesothelioma. A doctor makes incisions in the abdomen, while gas inflates the peritoneal cavity. The doctor then inserts a scope to locate and remove a tissue sample.
  • Mediastinoscopy: A minimally invasive biopsy used to diagnose pericardial mesothelioma. Doctors may also recommend this procedure if they suspect the cancer has spread to the chest. A doctor inserts a scope below the neck to locate and remove a tissue sample for analysis.
  • Thoracotomy: An open surgical procedure used to diagnose pleural and pericardial mesothelioma. A doctor makes an incision in the chest wall to collect a tissue sample from around the heart, lungs or other areas where tumors may be growing.

Therapeutic Surgery for Mesothelioma

Doctors may recommend surgery as a treatment option for eligible patients. In these cases, doctors perform surgical procedures to remove as much of the cancer as possible. Doctors often recommend a multimodal approach, or combining surgery with other treatments.

Patients may hear the terms “therapeutic,” “cytoreductive” or “curative” in relation to these types of mesothelioma surgeries. Although the terms are sometimes used interchangeably, they have important distinctions.

What’s the Difference Between Curative, Therapeutic and Cytoreductive Surgeries?

Therapeutic Surgery

Doctors administer therapeutic surgeries to return the patient to health and improve quality of life. Surgeries for mesothelioma may be considered therapeutic.

Curative Surgery

Doctors consider curative surgeries those that cure a condition, with little possibility of return. Mesothelioma does not have a cure and may recur, so surgeries are often not considered curative.

Cytoreductive Surgery

Doctors conduct cytoreductive surgeries to remove as much of the cancer as possible. As a result, cytoreductive surgeries for mesothelioma may be considered therapeutic.

Researchers continue to seek the most effective modes of surgical treatment for mesothelioma. Cytoreductive surgeries are often followed by radiation therapy or chemotherapy to kill remaining cancer cells and prevent recurrence. Researchers have reported improved survival rates in patients treated with surgery combined with radiation therapy and chemotherapy.

To be eligible for a therapeutic surgery, patients must meet certain criteria. Eligibility criteria may differ by the type of therapeutic surgery, but typically includes:

  • The patient must be relatively healthy
  • The diagnosis must be in early stages of cancer
  • There is little to no metastasis (cancer spread)

A patient’s cell type may also impact their eligibility. Typically, these surgeries are best for patients with epithelioid mesothelioma, as it does not spread as quickly as sarcomatoid mesothelioma.

Common Therapeutic Surgeries by Mesothelioma Location
  • Pleural mesothelioma: Pleurectomy and extrapleural pneumonectomy
  • Peritoneal mesothelioma: Peritonectomy and cytoreduction/debulking
  • Pericardial mesothelioma: Pericardiectomy

Palliative Surgery for Mesothelioma

Doctors may recommend palliative surgeries to alleviate the patient’s symptoms and improve quality of life. Patients with any stage of mesothelioma may undergo palliative surgeries. However, these surgeries are most common for stage 3 or stage 4 patients.

Many mesothelioma patients experience fluid buildup in the lungs, abdomen or heart. This fluid buildup may cause many symptoms, including chest or abdominal pain, difficulty breathing and shortness of breath.

Palliative surgeries can address these symptoms by draining the excess fluid and alleviating pressure in the chest or abdomen.

Palliative Mesothelioma Surgeries by Mesothelioma Location
  • Pleural mesothelioma: Pleurocentesis and pleurodesis
  • Peritoneal mesothelioma: Paracentesis
  • Pericardial mesothelioma: Pericardiocentesis
02. Surgery for Pleural Mesothelioma

Pleural Mesothelioma Surgery Options

Pleural mesothelioma develops in the lining of the lungs. Eligible patients may undergo therapeutic surgery, such as pleurectomy and extrapleural pneumonectomy. There are also palliative surgery options for malignant pleural mesothelioma patients. These procedures may drain excess fluid in the lungs and alleviate symptoms.

Therapeutic Surgeries for Pleural Mesothelioma

Doctors conduct therapeutic surgeries for pleural mesothelioma to reduce the presence of cancerous tissue. Pleural mesothelioma patients may undergo a pleurectomy or extrapleural pneumonectomy. Pleural mesothelioma specialists will determine the best surgical option depending on the patient’s health, cancer cell type and cancer stage.

Pleurectomy

A pleurectomy procedure removes the lining of the lung and visible tumors in the chest cavity. A pleurectomy is often part of a larger procedure known as a pleurectomy/decortication, or P/D.

The pleurectomy involves opening the chest and removing the lining of the lung. The decortication then removes any other detected masses within the chest cavity. If the cancer has spread outside of the lung, thoracic surgeons may also remove the pericardium (lining of the heart) and peritoneum (lining of the abdominal cavity).

In addition to treating mesothelioma, this surgery may also be used to prevent recurrence of pleural effusion.

Extrapleural Pneumonectomy

An extrapleural pneumonectomy (EPP) is an aggressive surgical procedure. EPP entails removal of one lung and its surrounding tissues, including the linings of the heart and abdomen, and parts or all of the diaphragm.

Because this surgery is more aggressive, patients must be in good overall health and have an earlier stage of mesothelioma to be eligible.

What Is It Like to Have an EPP Surgery?

Heather Von St. James was diagnosed with pleural mesothelioma in 2005. She had an initial prognosis of 15 months. She underwent an EPP, followed by chemotherapy and radiation. Today, she is a survivor of more than 14 years.

Palliative Surgeries for Pleural Mesothelioma

Pleural mesothelioma patients may experience uncomfortable symptoms. One of these common symptoms is pleural effusion, the buildup of excess fluid in the lungs. Pleural effusions may cause difficulty breathing, coughing and chest pain. Palliative surgeries for pleural mesothelioma can drain the excess fluid and alleviate patients’ symptoms.

Pleurocentesis

Doctors may recommend a pleurocentesis to remove excess fluid in the lungs (pleural effusion). When performing a pleurocentesis, doctors insert a needle into the pleural cavity to drain the excess fluid. Patients may also hear this surgery referred to as thoracentesis.

Pleurodesis

Pleurodesis is a surgery used to address pleural effusion. Pleural effusions cause a gap to develop between layers of the pleural membrane (pleural space). This gap allows fluid to accumulate. Pleurodesis closes the pleural space, preventing fluid buildup. This allows the lungs to fully expand, reducing the patient’s pain and improving breathing.

03. Surgery for Peritoneal Mesothelioma

Peritoneal Mesothelioma Surgery Options

Peritoneal mesothelioma affects the lining of the abdomen. There are therapeutic and palliative surgical options for peritoneal mesothelioma. For eligible patients, cytoreductive surgery may be combined with a heated chemotherapy called hyperthermic intraperitoneal chemotherapy (HIPEC). Surgery and HIPEC have been shown to be effective in treating peritoneal mesothelioma and extending patient life expectancy.

Therapeutic Surgeries for Peritoneal Mesothelioma

Peritoneal mesothelioma patients may qualify for therapeutic surgery options. Depending on the patient’s case, doctors may recommend a peritonectomy or cytoreductive and debulking surgery. For eligible patients, these surgeries may be part of a multimodal mesothelioma treatment plan. Peritoneal mesothelioma specialists will determine the best treatment option for patients based on various factors, including cancer stage and cell type.

Cytoreductive and Debulking Surgery

Doctors perform cytoreductive and debulking surgery to remove as many visible tumors from the abdominal region as possible. It may be an effective option for patients whose peritoneal mesothelioma has spread to other abdominal organs.

Mesothelioma surgeons may administer HIPEC treatment immediately following cytoreductive surgery to kill any remaining cancer cells and help prevent recurrence.

Peritonectomy

A peritonectomy is a type of cytoreductive procedure that involves removing the lining of the abdomen. If the cancer has spread, doctors may remove other impacted tissues. Researchers have seen success in extending patient life expectancy by combining a peritonectomy with HIPEC. In one study, researchers found 44% of peritoneal mesothelioma patients treated with cytoreductive surgery and HIPEC survived five or more years.

Palliative Surgery for Peritoneal Mesothelioma

Peritoneal mesothelioma patients may experience uncomfortable symptoms that impact their quality of life. A common symptom of peritoneal mesothelioma is peritoneal effusion, or fluid buildup around the abdomen. This may cause abdominal swelling and pain, vomiting and loss of appetite. Mesothelioma specialists may suggest palliative procedures for symptom reduction.

Paracentesis

Paracentesis drains the excess fluid from the abdomen. Doctors insert a hollow needle into the abdomen to remove the fluid buildup.

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.

04. Surgery for Pericardial Mesothelioma

Pericardial Mesothelioma Surgery Options

Pericardial mesothelioma is one of the rarest forms of the cancer. It affects the lining of the heart, called the pericardium. Early diagnosis is difficult for this type of mesothelioma. If the condition is caught in early stages, there may be therapeutic surgery options. However, due to late-stage diagnoses, patients typically undergo palliative surgery to relieve symptoms.

Therapeutic Surgery for Pericardial Mesothelioma

Due to its rarity and location, pericardial mesothelioma has fewer therapeutic surgical options than other types of mesothelioma. For eligible patients, therapeutic surgery may be combined with radiation and chemotherapy to prolong life expectancy.

Pericardiectomy

Pericardial mesothelioma can be treated with a pericardiectomy. Mesothelioma surgeons remove the pericardium, or lining of the heart. This allows the heart to continue pumping smoothly.

Palliative Surgery for Pericardial Mesothelioma

Because pericardial mesothelioma is difficult to diagnose early, palliative surgery is common for this type of mesothelioma. Palliative surgery may alleviate uncomfortable symptoms and improve patient quality of life.

Pericardiocentesis

Pericardiocentesis is a palliative surgery to relieve pericardial effusion, or a buildup of fluid around the heart. This condition can cause chest pain, arrhythmia and changes in blood pressure.

A pericardiocentesis procedure drains the excess fluid from the pericardial space, helping reduce symptoms. In some cases, doctors may suggest leaving a catheter in the pericardial cavity to drain as needed.

05. Side Effects of Surgery

Potential Side Effects of Surgery for Mesothelioma

Patients will experience different side effects based on the type of surgery, mesothelioma location, cancer cell type, cancer stage and patient characteristics. If surgery is combined with other treatments, such as chemotherapy or radiation, side effects will also vary. However, there are common surgery side effects patients should discuss with their medical team prior to treatment.

Common Mesothelioma Surgery Side Effects
  • Anesthesia complications
  • Bleeding and blood clots
  • Damaged organs
  • Fatigue
  • Heart complications
  • Infection
  • Loss of appetite
  • Low blood pressure
  • Numbness
  • Pain
  • Respiratory problems
06. Surgery Recovery Process

What Is the Recovery Process for Mesothelioma Surgery?

The mesothelioma surgery recovery process varies depending on the type of surgery. For example, patients who undergo more aggressive therapeutic surgeries may recover in the hospital for several weeks. These patients often also need additional recovery time at home.

Patients should talk to their doctor to understand what the recovery process will be like for their type of surgery.

General recovery processes for each type of surgery include:

  • Diagnostic surgery: Recovery from diagnostic procedures is relatively quick. Biopsies and other diagnostic surgeries are minimally invasive procedures. As a result, patients usually recover within a few days to one week. Typically, doctors recommend patients avoid strenuous activity and keep the incision site clean.
  • Therapeutic surgery: Therapeutic surgeries are often the most invasive and aggressive. Recovery from a serious procedure may take many weeks to months. For example, a patient may need 6 – 8 weeks to recover from an extrapleural pneumonectomy (EPP). It may take longer in some cases for the patient’s remaining lung to be able to function as needed.
  • Palliative surgery: Although palliative surgeries may be less invasive than therapeutic options, patients still need time to recover. Patients may need days or more than a week to recover from palliative surgery. After recovery, patients should feel relief from symptoms such as pleural effusion.

Recovery from surgery may differ for individual patients. When considering treatment options, patients should talk to their doctor about the recovery process, risks and benefits.

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