Mesothelioma Surgery

Surgery is a valuable treatment option for patients with an asbestos-related disease. It comes in many forms, from procedures aimed at diagnosing a cancer and alleviating pain to complex surgeries that involve a more experienced mesothelioma surgeon.

Surgery can be an optimal approach to treating mesothelioma, particularly if it is part of an aggressive, multi-modal strategy that includes chemotherapy and radiation. You can live for many years after surgery if your cancer has not metastasized and an experienced surgeon is able to remove all visible signs of the disease.

Before discussing surgery as an option, doctors will want to make sure your body is strong enough to recover, so they will determine your lung and heart health by conducting a pulmonary function test and running cardiac tests, such as an electrocardiogram (EKG), a stress test, an angiogram or an echocardiogram.

If your doctor believes you are a candidate for surgery – that is, your overall health is strong enough to withstand potential complications and your mesothelioma has not spread too far – then it is something to consider. There are risks, but successful surgery also comes with curative potential.

There are many examples of mesothelioma survivors on our website. Many of the people on our Wall of Hope opted for surgeries that gave them more years to spend with children and grandchildren. Some procedures were more aggressive than others.

Three Surgery Categories

Sometimes curative surgery is not an option, but other procedures are. Surgeries generally fall into three categories: potentially curative, palliative and diagnostic.

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Potentially Curative

Major surgery can be life changing. This type of surgery removes tumors and extends life expectancy.

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Palliative surgery is to improve quality of life by easing a patient's pain or alleviating symptoms.

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The most basic of procedures. It gives patients and doctors a better idea of disease progression.

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Potentially Curative Surgery

There are two types of potentially curative surgeries being used for pleural mesothelioma and one for peritoneal mesothelioma. All three are used as part of a multi-modal approach to therapy. Extrapleural Pneumonectomy (EPP) and Pleurectomy/Decortication (P/D) are performed on pleural mesothelioma patients. Cytoreductive surgery is an option for someone with peritoneal mesothelioma.

Both EPP and P/D are major medical procedures, but surgeons often differ on which procedure they recommend. Which surgery is better is a debate being waged among medical professionals in the mesothelioma community. It's a choice you may have to make, based on your situation, your expectations and your specialist.

EPP surgery lends itself to a higher rate of complication than the P/D procedure. Both are considered when the diagnosis is made at a relatively early stage, when doctors are confident that the disease has not spread and that the benefits are worth the risks of serious complications.

Both require an experienced mesothelioma surgeon at a major cancer center. Here is a side by side statistical analysis of the two:

Extrapleural Pneumonectomy

Extrapleural Pneumonectomy Survival Chart

EPP is an aggressive surgery that involves the removal of an entire lung, the lining around it, parts of the pericardium and diaphragm, and the lymph nodes nearby. Theoretically, it offers the best chance to remove all of the cancer cells.

Studies By:

  • Dr. Sugarbaker 1999 Median Survival 19 months
  • Dr. Allen 1994 Median Survival 13.3 months
  • Dr. Rusch 1996 Median Survival 9.9 months
  • Dr. Pass 1997 Median Survival 9.4 months
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Pleurectomy Decortication

Pleurectomy Decortication Survival Chart

P/D is less life-changing but has shown equally effective results. It leaves the lung intact, but is considerably more detailed and takes even longer to complete. It removes the pleural lining surrounding the lungs, and all visible tumors.

Studies By:

  • Dr. Rusch 1996 Median Survival 18.3 months
  • Dr. Pass 1997 Median Survival 14.5 months
  • Dr. Allen 1994 Median Survival 9 months
  • Dr. Achatzy 1989 Median Survival 10 months
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Debulking Surgery for Peritoneal

Cytoreductive surgery is often referred to as debulking surgery and involves removing as much of the cancerous growth as possible from inside the abdominal cavity. Like the pleurectomy, it is detailed surgery that can take several hours to complete.

Robotic Surgery Is Newest Technique

Surgical Robot

Robotic surgery is the newest way for thoracic surgeons to conduct cancer surgeries. They have used the more precise surgery for a decade, typically for minimally invasive procedures, but since about 2006 they began using it for chest cancer surgeries. Dr. Farid Gharagozloo of the University of Arizona Cancer Center performed the first robotic EPP in 2013, and he said it can change the future of mesothelioma treatment. "It's a better pair of scissors," Gharagozloo said.

The da Vinci Surgical System Robot does the hard work and allows for more precise movement, a more magnified view and better maneuverability during the operation. Surgeons do their work on a computer board, which guides tiny instruments that are attached to a robotic arm. Robotic surgery shortens recovery time because it dramatically reduces blood loss. It also reduces the stress on the remaining lung, which is often a major problem when the surgery is done conventionally.

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Palliative Surgery

Palliative surgery is designed for mesothelioma patients who opt against the more aggressive, potentially curative options or when those options are no longer available because the cancer already has spread or because the patient is not healthy enough to withstand the strains of major surgery. It is considerably less invasive.

The goal of palliative surgery is to improve your quality of life. That gets accomplished by relieving you of as many symptoms as possible and by providing you pain relief. There is no pretense of a cure, but palliative procedures can prolong your life and make your cancer a little more tolerable. Many of these surgeries involve the removal of fluids.

  • Pleurodesis

    Pleurodesis is a procedure that is done in an attempt to prevent fluid buildup in the chest. A hollow tube is inserted into the chest wall to drain the fluid, and it also is used to insert substances that can help a patient. It can be used for talc powder, an antibiotic, or a chemotherapy drug like bleomycin.

    Learn more about pleurodesis
  • Paracentesis

    Paracentesis is another surgical procedure that can remove fluid buildup from the abdominal cavity for patients with peritoneal mesothelioma. It can help alleviate symptoms that include stomach pain and breathing difficulties.

    Learn more about paracentesis
  • Thoracotomy

    Surgeons perform a thoracotomy to access the lungs, heart, aorta, trachea or diaphragm. For someone with mesothelioma or asbestos-lung cancer, this could include a wedge resection, a lobectomy, or a pneumonectomy.

    Learn more about thoracotomy
  • Wedge resection

    Also known as a segmentectomy, a wedge resection is the least invasive of these procedures and is often used when the cancer is confined to a single area. The surgeon will leave much of the lung intact, removing only a small section that often is wedge shaped.

  • Lobectomy

    This involves the removal of at least one of the five lobes that are in the lungs. It is a more extensive procedure than the wedge resection, and often used if the cancer is confined to a single lobe.

  • Pneumonectomy

    This is the most extensive surgery of the three thoracotomies because it involves removing a lung. The procedure usually includes the removal of the lining around the lung. A patient may opt for this surgery if cancer hasn't spread beyond one lung.

    Learn more about pneumonectomy

Other Surgeries

Shunt Placement involves implanting a device that moves the fluid within the body from one part to another with the hope that is more likely absorbed and less likely to cause problems for the patient.

Catheter Placement is sometimes used to control the fluid buildup. A tube is placed in either the abdomen or chest through a small incision. One end is left outside the body, allowing the fluid to drain regularly without the need of a doctor's visit.

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Diagnostic Surgery

Scientist Analyzing Biopsied Cells

Biopsies and fine needle aspirations are the most common types.

Diagnostic surgery is used to confirm the presence – and whereabouts -- of cancer. This is typically accomplished with a biopsy, which is the removal of tissue from inside the body to determine if cancer is present. Some of the more common biopsies include fine needle aspiration, incisional/core biopsy and excisional biopsy.

Fine needle aspiration biopsies use a hollow needle to gather sample cells for testing. Results from this biopsy are available within a few minutes. Incisional/core biopsies only remove a small section of suspicious tissue for further evaluation. An excisional biopsy involves the removal of an entire tumor or organ for diagnosis.

Typical biopsies for patients with lung conditions include thoracentesis and thoracoscopy, which can be used to diagnose patients who are suspected to have pleural mesothelioma or another lung condition.

A thoracentesis is used to diagnose patients who are suspected to have pleural mesothelioma. The procedure may also be used as a palliative treatment for patients who are experiencing excess fluid in the lungs. Such fluid is removed by inserting a hollow needle into the lungs. The fluid is then analyzed for the presence of disease.

During a thoracoscopy, a doctor makes an incision in the chest. A long, thin tube is inserted into the tissue surrounding the lungs, called the pleura. The doctor probes the pleura and takes samples of suspected mesothelioma cancer cells for testing.

Mesothelioma Surgeons

Research shows – and mesothelioma specialists agree – that surgery is the best first option for living longer with this disease. Sometimes the options are clear-cut, sometimes they're not. But it is hard to understate how surgery can prolong your life.

A mesothelioma specialist can assess each individual patient and explain what procedures make the most sense for your individual circumstance. They will take into account several factors, including the stage of the disease and the overall health of the patient.

One of the most important decisions you can make will be the selection of a doctor and treatment center. This is a very intricate and rare cancer, which requires a specialist who is comfortable with treating it. Our Doctor Match Program helps patients find top mesothelioma specialists and helps get appointments for patients.

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Additional Resources

Karen Selby is a registered nurse and a Patient Advocate at The Mesothelioma Center. She worked in several subspecialties within nursing before joining in 2009.

  1. Pass, I., Vogelzang, N., Carbone, M. Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Transitional Therapies. Springer: New York. 2005.
  2. Baldi, A., Mesothelioma from Bench Side to Clinic. Nova Biomedical Books: New York. 2008.
  3. Bhimji, S. (2010, November 1). Biopsy. U.S. National Library of Medicine, National Institutes of Health. Retrieved from:
  4. Roberts, J.R. (1999). Surgical Treatment of Mesothelioma: Pleurectomy. Chest (116, 446S-449S). Retrieved from:
  5. Encyclopedia of Surgery. (n.d.). Pneumonectomy. Retrieved August 21, 2012, from:
  6. Eldridge, L., MD. (2012, April 6). Pneumonectomy as a Treatment for Lung Cancer. Retrieved from
  7. Pneumonectomy. (2008, October 21). Aetna, Inc. retrieved from:

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