Mesothelioma Surgery
Mesothelioma surgery allows doctors to remove cancerous tissue and relieve symptoms. Surgical options depend on the type of mesothelioma, such as pleural or peritoneal, and may be part of a multimodal treatment plan. Surgery-based approaches generally result in the most favorable prognoses.
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What Is Surgery for Mesothelioma?
Mesothelioma surgeries are medical procedures that remove tumors from a person’s body. Doctors may recommend surgeries for different purposes. Surgery can be a way to treat mesothelioma. It can also help diagnose cancer, manage symptoms and boost quality of life.
- Eligibility: Patients with stage 1 – 3 disease, non-sarcomatoid tumors and good overall health may qualify for surgery.
- Benefits: Surgery may extend survival, improve quality of life and contribute to long-term remission.
- Complications: Risks include bleeding, infection, pain, damage to healthy tissues and anesthesia complications.
- Long-term survival: About 60% of long-term pleural mesothelioma survivors underwent surgery in a National Cancer Database analysis.
- Survival for pleural mesothelioma: Patients treated with surgery, chemotherapy and immunotherapy had a 53% two-year survival rate.
- Survival for peritoneal mesothelioma: One study found a 100% five-year survival rate among selected patients treated with repeat surgery and heated chemotherapy.
Each patient’s mesothelioma surgery options depend on several factors. These include the patient’s overall health, cancer stage and type of mesothelioma.
Doctors also consider a patient's personal goals when weighing potential surgeries. If a surgery-based plan makes sense, it may have any of the following purposes:
- Diagnosis: Diagnostic surgery procedures help determine the cause of a patient’s symptoms. Biopsies are a common type of diagnostic surgery for all types of mesothelioma.
- Patient support: Palliative surgeries help manage symptoms and improve quality of life. Surgeries that drain cancer-related swelling (effusion fluid) are common palliative procedures for most types of mesothelioma.
- Tumor removal: Therapeutic surgeries aim to extend survival by removing tumors. Pleurectomy/decortication is a common therapeutic surgery for pleural mesothelioma.
Some patients may be eligible for multimodal treatment, which combines two or more therapies. It is often the most effective way to extend life expectancy for mesothelioma patients. Treatment plans commonly include surgery with radiation, chemotherapy or immunotherapy.
In a recent study, looking at 350 pleurectomies, having heated intrapleural chemotherapy affected survival in a very significant way compared to patients that did not.
Raphael Bueno, MD
Who Is Eligible for Mesothelioma Surgery?
Eligibility for mesothelioma surgery depends on many elements, including the patient's overall health. The type and stage of the cancer also affect who may qualify. Doctors weigh these factors before recommending surgery or advising against it.
| Likely Qualified | Possibly Not Qualified | |
|---|---|---|
| Cancer Stage | 1 – 3 | 3 – 4 |
| Cell Type | Epithelioid, biphasic | Sarcomatoid |
| General Health | Good general health | Serious health problems |
| Heart and Lung Health | Healthy heart and lung function | Heart problems or reduced lung capacity |
| Recovery Ability | Can withstand a lengthy recovery process | Can't withstand surgery or a lengthy recovery |
| Smoking Status | Never smoked or former smoker | Current smoker |
Some patients may not qualify for surgery when first diagnosed. But other treatments that reduce the tumor size may make them eligible later. For example, a method of administering chemotherapy called PIPAC shrunk tumors so much in some patients that surgery became a secondary treatment option.
Patients interested in surgery should discuss their options with a mesothelioma surgeon. An experienced specialist can help patients understand the potential risks and benefits.
Did You Know?
The survival rate for mesothelioma patients who undergo surgery increases substantially.
Not all patients are candidates for surgery, but for those who are, identifying an experienced surgeon quickly can have a positive impact on survival.
Surgery for Pleural Mesothelioma
Common pleural mesothelioma surgeries include pleurectomy/decortication (P/D) and extrapleural pneumonectomy (EPP). These procedures range from minor to extensive. In general, symptom-management surgeries are less serious, but those intended to extend life are more aggressive operations.
- Goal: To extend life in combination with other treatments
- Description: A surgery that removes the lining around the lung (the pleura) and leaves both lungs in place
- Goal: To extend life in combination with other treatments
- Description: A risky surgery that removes the pleura and the affected lung
- Goal: To ease symptoms
- Description: A surgical procedure that drains excess fluid from the lining around the lung
- Goal: To ease symptoms
- Description: A surgical procedure that helps prevent fluid buildup around the lung
Surgery for Peritoneal Mesothelioma
Peritoneal mesothelioma surgeries may aim to improve symptoms or extend survival. Options include cytoreductive surgery (CRS) and paracentesis. CRS is also known as debulking or peritonectomy. It is usually followed by HIPEC, which stands for heated intraperitoneal chemotherapy. It is a hot chemotherapy wash applied to the abdomen.
- Goal: To extend life in combination with other treatments like HIPEC
- Description: A type of cytoreductive surgery that removes the lining of the abdomen (the peritoneum) and other visible tumors
- Goal: To ease symptoms
- Description: A surgical procedure that drains excess fluid from the lining of the abdomen
Patients may also undergo other types of chemotherapy after CRS, including:
- Early postoperative intraperitoneal chemotherapy (EPIC)
- Normothermic intraperitoneal chemotherapy (NIPEC)
- Pressurized intraperitoneal aerosol chemotherapy (PIPAC)
Other Surgeries for Mesothelioma
Surgical options vary based on the location of the cancer, meaning each type of mesothelioma has different procedures. Pericardial and testicular mesothelioma are both rare types of mesothelioma. As such, surgery options for testicular and pericardial mesothelioma are not well documented. Experienced doctors can determine surgery eligibility based on a patient’s individual case.
- This surgery may aim to relieve symptoms or extend survival. It consists of removing all or part of the lining around the heart.
- This surgical procedure aims to relieve symptoms of pericardial effusion. It consists of draining excess fluid from the lining around the heart.
Testicular mesothelioma is one of the rarest forms of asbestos cancer, accounting for less than 1% of all mesothelioma cases. Specific treatment guidelines for testicular mesothelioma have not yet been developed. Doctors may recommend a radical orchiectomy, a surgery to remove the affected testicle, to treat this disease.
Some evidence shows that surgery for testicular mesothelioma is more effective at extending survival than surgery for other types of mesothelioma.
Surgical Procedures for Diagnosing Mesothelioma
Patients with any type of mesothelioma may undergo minor surgeries to help diagnose their conditions. Types of diagnostic surgeries include:
- Laparoscopy: A doctor makes a small incision in the abdomen and inserts a device called a laparoscope. This device can collect samples and also has a camera component. It is commonly used to diagnose peritoneal mesothelioma.
- Laparotomy: A doctor makes a large incision in the abdomen. This allows the doctor to directly collect samples and view tissue. These samples can be used to diagnose peritoneal mesothelioma.
- Mediastinoscopy: A doctor makes a small incision in the chest and inserts a device called a mediastinoscope. The device is similar to a laparoscope. It may be used to diagnose malignant pleural mesothelioma.
- Thoracoscopy: A doctor makes a small incision in the chest and inserts a device called a thoracoscope. The device is similar to a laparoscope. It is the preferred method for obtaining an adequate biopsy sample in pleural mesothelioma patients.
- Thoracotomy: A doctor makes a large incision in the chest. The procedure is similar to a laparotomy and may be used to collect samples to diagnose pleural mesothelioma.
Mesothelioma patients may also undergo surgery as a form of palliative care. Any surgery intended to treat symptoms or boost quality of life can be considered palliative.
Questions About Mesothelioma Surgery? Ask experienced mesothelioma advocate Jennifer Lucarelli Ask a Question
Mesothelioma Prognosis After Surgery
Surgery-based combination treatments generally provide the best prognosis for mesothelioma. In studies, patients have lived 5 years and longer with this type of treatment. Life expectancy after surgery depends on patient factors and treatment details. Tumor cell type and location can also affect prognosis and surgery eligibility.
- Treatment: Chemotherapy, surgery and optional post-surgery chemo
- Key Results
- Median survival: 57 months
- 3-year survival rate: 65%
Source: The Annals of Thoracic Surgery
- Treatment: Surgery and heated chemotherapy (HIPEC)
- Key Results
- Median survival: 67 months
- 3-year survival rate: 62%
Source: Cancer
The multimodal plans above extended survival further than individual treatments. Patient survival times for solo treatments include:
- Pleural mesothelioma treated with checkpoint inhibitors: 18 months
- Peritoneal mesothelioma treated with chemotherapy drugs: 13 months
Surgery-based multimodal therapies may improve survival for pericardial and testicular mesothelioma patients. Anyone interested in mesothelioma surgery should discuss their options with an expert. Doctors who specialize in this rare cancer can explain the benefits and risks. They may also recommend clinical trials that offer access to experimental treatments.
Can Mesothelioma Be Removed or Cured With Surgery?
Doctors can remove mesothelioma tumors using surgery, but surgery alone cannot cure the cancer.
Surgery tends to be more successful at the earlier stages. Even so, it usually cannot get every cancer cell on its own, which is why patients typically undergo surgery plus other treatments. The extra therapies, like chemo, help kill cells left behind by surgery. These combination treatments generally offer the best prognosis. In fact, many long-term survivors received surgery-based combination treatments.
Mesothelioma Surgery Side Effects
Like all medical procedures, mesothelioma surgery carries a risk of side effects and complications. Common side effects include pain and fatigue during recovery. Possible complications include bleeding, infection, blood clots, pneumonia and respiratory problems. However, these issues do not affect every patient. Mesothelioma surgeons can explain the likelihood of side effects and complications based on the type of surgery and a patient's overall health.
- Anesthesia complications
- Bleeding
- Blood clots
- Damage to nearby tissues
- Digestive problems
- Fatigue
- Heart complications
- Infection
- Pain
- Pneumonia
- Respiratory problems
Some factors may increase a person’s chance of experiencing surgery side effects. For example, negative effects may vary if surgery is combined with other treatments, like chemotherapy and radiation. Patients can discuss potential side effects with their oncology teams. After surgery, the mesothelioma cancer center or oncology team can help manage post-surgical conditions.
Learn About Financial Assistance Available for Treatment Costs Learn more with our free information packet Get Help NowWhat Is the Recovery Process for Mesothelioma Surgery?
The mesothelioma surgery recovery process varies depending on the procedure performed. With a diagnostic surgery, patients may only need a few days to return to their normal routines. For more serious operations, recovery may be months long.
Surgery Recovery Tips
According to experts, patients should keep a few things in mind during surgery recovery:
- Anesthesia effects: Medications used in surgery can affect your mental processes. It's best to avoid driving, drinking alcohol and making important decisions for a few days.
- Food and water: Surgery can make eating and drinking a bit difficult. Unless your doctor says otherwise, it's a good idea to drink 8 glasses of water each day. A balanced diet with plenty of fruits and vegetables may also help.
- Movement: Surgery may leave you feeling stiff and sore, but gradually increasing your activity can help. Check with your doctor to understand when it is safe to resume your usual activities.
- When to get help: Doctors recommend contacting your surgeon if you have:
- A fever higher than 101°F
- No bowel movements within a few days of surgery
- Ongoing or worsening pain
- Prolonged vomiting
- Redness, swelling, bleeding or drainage from an incision
- Severe abdominal pain or swelling
Talk to your doctor before surgery to understand the expected recovery process. This can help ensure you're fully prepared and can return to your daily activities as quickly as possible.
Common Questions About Surgeries for Mesothelioma
How long does mesothelioma surgery take?
How successful is surgery for mesothelioma?
Which are the most common therapeutic surgeries for pleural mesothelioma?
Note: This page contains statistics gleaned from large groups of patients. These statistics cannot forecast a single patient’s risk, cancer experience or the success of any given treatment. Patients should discuss all cancer screening and treatment decisions with an experienced oncologist.
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Dr. Francis Perry Wilson is the Director of the Clinical and Translational Research Accelerator at the Yale University School of Medicine. He specializes in nephrology and clinical research.
Amy Zappone brings nearly two decades of experience in education and research-based communication. At Mesothelioma.com, she translates complex topics into understandable resources that help patients and families make informed decisions.
