Mesothelioma Surgery

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Expert Take

Dr. Jeffrey Velotta: What types of surgeries are available for mesothelioma treatment?

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Surgery types available for mesothelioma include two main types. So the first that was originally originated with Dr. Sugarbaker at the Brigham and Women's Hospital was the extrapleural pneumonectomy, otherwise known as EPP. And the idea behind that surgery was that you remove the entire lung and all the pleural surface, the parietal and visceral layer, as well as the diaphragm and the pericardial lining. So that was the kind of first nuanced approach where that was all done.

And then the second, more newer approach, slightly less invasive, and with slightly better results now is called the pleurectomy and decortication. And that's a lung sparing operation where you take all that pleural lining, the mesothelium lining, but save the lung. You still take the heart lining, as well as the diaphragm and the diaphragm lining, but you save the lung.

And I think that's based on clinical trials and multiple studies now, it would be now for surgery, the more gold standard would be pleurectomy and decortication. Since the MARS trial in 2011, we're really seeing the majority of people now doing pleurectomies and decortication versus extrapleural pneumonectomy are kind of in the more rare instances. So pleurectomy and decortication is kind of what I feel is the standard treatment now for surgical management of mesothelioma.

What Does Mesothelioma Surgery Do?

Diagnostic surgeries, such as biopsies, identify the type of disease. Curative mesothelioma surgeries remove tumors to extend survival, while palliative surgeries relieve symptoms like fluid buildup and pain. No surgery can cure mesothelioma, but aggressive curative approaches can significantly extend life expectancy in eligible patients. Surgery is most effective as part of a multimodal plan that may include chemotherapy, radiation or immunotherapy. 

Key Facts About Mesothelioma Surgery

1. Mesothelioma surgery can improve a patient’s prognosis, extend survival and improve the overall quality of life.
2. About 27.6% of pleural mesothelioma patients received surgery between 2004 and 2020, according to the National Cancer Database.
3. About 50% to 69% of peritoneal patients who undergo cytoreductive surgery with heated chemotherapy (HIPEC) live longer than 5 years.
4. Pain and swelling around the incision are the most commonly reported complications of surgery.

Therapeutic mesothelioma surgeries cut out visible tumors. Surgeons also remove as much tissue where mesothelioma cells have spread as possible to help people live longer. Palliative mesothelioma surgeries address issues such as pain, discomfort and trouble breathing with procedures to remove and prevent unwanted fluid from returning. 

Surgery is often part of multimodal therapy plans for mesothelioma. Doctors may recommend chemotherapy to kill any remaining cancer cells after surgery and radiation to prevent local recurrence. Immunotherapy may help as a maintenance therapy. These mesothelioma treatments improve the chance of long-term survival in combination with surgery. In some cases, chemotherapy or immunotherapy is given before surgery rather than after. This approach, called neoadjuvant therapy, can shrink tumors before resection and may improve surgical outcomes for select patients. Your oncologist and surgeon will determine the right sequencing for your treatment plan.

Who Is Eligible for Mesothelioma Surgery?

You may be eligible for mesothelioma surgery if you’re in good overall health and your doctor is confident you can recover from potential complications. You may not qualify if you have the biphasic or sarcomatoid cell type, late-stage cancer or certain preexisting conditions. 

Cancer stage is the most important eligibility factor, according to nearly 56% of mesothelioma surgeons in our exclusive survey. A surgical consultation is the best way to determine whether you qualify. 

Eligibility for surgery is thoroughly vetted during a surgical consultation, where the surgeon and the surgical team review your medical history, imaging scans and biopsy results. If you qualify for surgery, you also may be able to join a mesothelioma clinical trial of other treatment options. Mesothelioma surgeons can offer patients the opportunity to participate in clinical trials to investigate the best therapies to combine with surgery. If you’re unsure where to start, our Patient Advocates can help connect you with a top mesothelioma surgeon at no cost to you.

If your doctor confirms you’re a surgical candidate, expect preoperative testing that typically includes pulmonary function tests, a cardiac evaluation, blood work and updated imaging. Your team will also advise you to stop smoking and pause certain medications ahead of surgery. Arrange for a home caregiver for the first several weeks of recovery. If you are being evaluated for EPP, expect spirometry as well, since your remaining lung must compensate after the procedure.

Types of Surgery for Mesothelioma: Diagnostic, Curative and Palliative

In addition to curative and palliative procedures, other types of surgery for mesothelioma include diagnostic, staging and supportive surgeries. Each of these can play an important role in your mesothelioma journey. 

Dr. Jacques Fontaine, thoracic surgeon and director of the Mesothelioma Research and Treatment Center at Moffitt Cancer Center in Tampa, told us, “There’s two categories of surgery we can offer. Palliative surgery’s goal is to improve quality of life. The goal of curative surgery for mesothelioma is to remove all the disease that can be seen with the naked eye.”

Common Curative Types of Mesothelioma Surgery

• Cytoreductive surgery with HIPEC: This curative surgery for peritoneal mesothelioma removes visible tumors before applying heated chemo directly to the abdomen. 
• Extrapleural pneumonectomy: This surgery for pleural mesothelioma removes the entire lung. Because EPP is a very aggressive surgery, surgeons perform it less often than lung-sparing surgeries.
• Pericardiectomy: Also known as a pericardial window, this surgery for pericardial mesothelioma removes part or all of the heart’s lining to take out tumors or relieve fluid buildup. It may improve symptoms and extend life.
• Peritonectomy: A peritonectomy is an aggressive surgery that removes visible tumors from the abdominal lining to treat peritoneal mesothelioma. A type of cytoreductive surgery, it’s often paired with HIPEC. 
• Pleurectomy with decortication: While P/D is an aggressive surgery for pleural mesothelioma, it’s a lung-sparing surgery. It’s considered less aggressive than EPP and doctors perform it more often.

Diagnostic surgeries include surgical biopsy, which is a procedure where a surgeon removes part or all of a lump or abnormal tissue through a small cut to help diagnose mesothelioma. It may be done in a hospital or clinic using local or general anesthesia, and the removed tissue is sent to a lab for testing. Staging surgery helps doctors see how far mesothelioma has spread in the body. It may involve procedures like laparoscopy or endobronchial ultrasound/mediastinoscopy, where a small camera is used to look inside and take tissue and lymph node samples.

Supportive surgery for mesothelioma is similar to palliative surgery in that it doesn’t remove tumors or aim to be curative. Its goal is to help other mesothelioma treatments work better. An example of a supportive surgery is placing a catheter or port to deliver chemo more effectively. 

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Pleural Mesothelioma Surgery Options

Surgical treatment for pleural mesothelioma targets cancer in the lung’s outer lining through 2 main approaches: curative procedures that remove tumors and palliative procedures that manage symptoms.

Pleural mesothelioma surgeries are often part of multimodal therapy, which combines major, tumor-removing surgery with other treatments, including radiotherapy and chemo. This aggressive treatment approach can extend life expectancy.  

Pleural Mesothelioma Surgeries

• EPP: An entire lung, the lining around it (possibly including the diaphragm and pericardial layers) and nearby lymph nodes are removed. 
• Partial pleurectomy: Part of the pleura, the thin lining around the lungs, is removed to take out visible mesothelioma tumors and ease symptoms like shortness of breath. It’s less aggressive than removing the entire pleura and may be offered when full tumor removal isn’t possible.
• P/D: The pleural lining around the lungs (possibly including the diaphragm and pericardial layers) and all visible tumors are removed as well as nearby lymph nodes. Surgeons scrape the surface of the diseased lung rather than removing the organ. 
• Pleurodesis: It seals the space between the lung and chest wall to prevent fluid or air from building up again. It causes inflammation that fuses the pleural layers together.
• PleurX catheter placement: Surgical placement of a small silicone catheter (PleurX) allows you to drain pleural fluid at home every 2 to 3 days without undergoing another thoracentesis. 
• Thoracentesis: A doctor can drain pleural fluid with a hollow needle to relieve chest pressure, allowing the lungs to expand to improve breathing.

About 15% to 20% of patients with pleural mesothelioma qualify for aggressive surgery. Specialists will recommend the treatment for mesothelioma that best meets your needs and goals. When deciding between pleurectomy versus pneumonectomy, for example, surgeons will consider your unique medical needs and preferences. These surgeries may take several hours to complete, and recovery time varies depending on the procedure.

Pleurectomy With Decortication (P/D)

The goal of pleurectomy and decortication is to take out as much cancer as possible without removing the lung. Doctors offer P/D to people with pleural mesothelioma that hasn’t spread too far into the lung or nearby tissue. You must be medically able to tolerate surgery and recovery. Its lung-sparing approach has made P/D the preferred surgical option, achieving outcomes similar to EPP with a reduced risk of complications. P/D may help people live longer. It keeps the lung in place, which helps you breathe better. But there are some risks. You may have bleeding, air leaking, infection or pain after surgery. Recovery time may be lengthy, but many people feel better as they heal. Doctors and nurses will help you manage side effects.
The median survival with P/D is 22 months. A 2024 long-term survival analysis published in the journal Clinical Lung Cancer found the P/D group had 10-year overall survival rates of 16%, significantly higher than any other group. P/D typically takes 3 to 5 hours. Most patients remain in the hospital for 7 to 10 days after surgery before recovering at home.

Survivor Story

Linda Hooper: Undergoing Mesothelioma Surgery

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The first treatment for the mesothelioma was a pleurectomy decortication, which is an operation.

They cut through the middle of your back, between your ribs to the almost the middle of your front.

It was supposed to be a eight inch incision, but it looks more like twelve.

It, they had to remove a rib.

They took the cancer that was collected around my the plural, lining of my lung and it was scraped off. I had six lymph nodes cut off. Two of them turned out also positive for mesothelioma.

So I was pretty close to the stage where I was still a candidate to have the operation done, because it hadn’t, spread further.

Extrapleural Pneumonectomy (EPP) for Mesothelioma

The goal of extrapleural pneumonectomy is to take out as much cancer as possible. EPP removes one lung, the lung lining, part of the diaphragm/pericardium and some nearby tissue. 

Doctors may recommend it when the mesothelioma hasn’t spread far, and you’re able to tolerate surgery. Your doctor will check your overall health, lung strength and if the cancer is only on one side of your chest. If your heart and other lung are healthy, you may be able to have an EPP. Doctors also check whether other treatments, such as chemo or radiation, will help after surgery.

Michael Cole

Verified Asbestos.com Survivor

Don’t Be Afraid of Aggressive Mesothelioma Treatment

When I was diagnosed with malignant pleural mesothelioma my specialist told me extrapleural pneumonectomy surgery with heated intrathoracic chemotherapy, or HITHOC, was the best course of action for my case. I said, ” I want you to get everything you can see, everywhere you think it might be hiding and everywhere you think it might go.” He was visibly relieved when I told him that.

Michael Cole

Verified Asbestos.com Survivor

Read Michael’s Story

EPP can remove most visible cancer and may improve survival, but it carries significant risks.  Research published in the European Journal of Cardio-Thoracic Surgery in 2024 found experienced surgical centers had a 90-day mortality rate of 7.2% with EPP compared to nearly 0% for P/D. Removing a lung can make breathing harder and require a longer recovery. This is why doctors don’t often perform EPP today, preferring lung-sparing surgeries. EPP typically takes 4 to 6 hours. Most patients spend approximately 2 weeks recovering in the hospital before going home.

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Peritoneal Mesothelioma Surgery Options

The most effective surgery for peritoneal mesothelioma is tumor removal or cytoreductive surgery with HIPEC. In the first step of this 2-step procedure, all visible tumors in your belly are removed. This can mean removing part or all of the lining around your abdomen (the peritoneum) and parts of your spleen, stomach and intestines if needed. In the second step, a heated chemo wash is applied directly into your belly to kill any remaining cancer cells. Cytoreductive surgery with HIPEC is one of the longest mesothelioma procedures, often taking 6 to 10 hours depending on how extensively tumors have spread. Most patients stay in the hospital for 1 to 2 weeks after surgery.

Surgeries for Peritoneal Mesothelioma

• Omenectomy: This is typically done during cytoreductive surgery with HIPEC. An omentectomy removes an apron of the peritoneum called the omentum to remove as much cancerous tissue from your body as possible. 
• Paracentesis: This is a palliative surgery commonly performed to drain excess fluid buildup. To avoid the need for multiple paracenteses, small, flexible tubes or indwelling peritoneal catheters (tunnel or PeritX) may be inserted to drain fluid. They can be left in place, allowing you to manage ascites at home.
• Peritonectomy: This is done during cytoreductive surgery. Peritonectomy removes diseased parts of the peritoneum, the lining around the cavity and organs in your belly. 

Cytoreductive surgery with HIPEC improves symptoms and extends survival. Patients who undergo repeat HIPEC with surgery live an average of 67.7 months, according to a 2022 study in Annals of Surgical Oncology. Risks include infection, digestive issues, excessive bleeding and constipation.

This combination is considered the gold standard for treating peritoneal mesothelioma, offering patients an average survival of about 4.5 years (53 months), with some living 10 years or longer. Studies show when combined with systemic chemotherapy, the 5-year survival rate can reach as high as 65% to 80%, a marked improvement compared to other treatments.

Insight From a Mesothelioma Specialist

“I think the best treatment for peritoneal mesothelioma is a combination of HIPEC as well as what we call a cell reductive procedure. This includes the peritonectomy procedure.”

Dr. Charles Conway, Director of Surgical Oncology at the Ridley-Tree Cancer Center

Pericardial Mesothelioma Surgery Options

Surgeries for pericardial mesothelioma focus on relieving symptoms because tumors have often spread into the heart muscle before symptoms appear, leading to diagnoses in advanced stages. While doctors typically can’t remove the tumors, procedures like pericardiectomy and pericardiocentesis can remove affected tissue and drain fluid to reduce pressure and pain. These procedures have varying success rates and carry a higher risk of serious complications.

Surgeries for Pericardial Mesothelioma

• Pericardiectomy: Removes as much cancerous tissue as possible from the heart lining, or pericardium. It can relieve symptoms such as difficulty breathing, chest pressure, heart palpitations and fatigue.
• Pericardiocentesis: Similar to thoracentesis and paracentesis, but the fluids are removed from around the heart rather than the lungs or abdomen. Doctors treat recurrent pericardial effusions with repeat pericardiocentesis procedures.

These procedures can improve quality of life and relieve symptoms like shortness of breath, coughing and chest pressure. Risks include infection, abnormal heart rate and cardiac arrest. After you get home from surgery, you should contact your doctor if drainage from the incision increases or you notice chest pain or severe symptoms.

Surgery for Testicular Mesothelioma

The most common treatment for testicular mesothelioma is inguinal orchiectomy, a surgery to remove one or both testes along with the spermatic cord. The risks include bleeding, infection, swelling and pain.

A urologic oncologist, a specialist in cancers of the urinary tract and reproductive system, typically performs the surgery. The surgeon may also perform a lymphadenectomy to remove nearby affected lymph nodes. 

Disease-specific survival rates are higher among testicular patients compared to pericardial patients. About 58% survive 5 years after diagnosis, with 45% surviving 10 years. Disease-specific survival measures how many people die from the cancer compared to other causes. 

The statistics about surgery are based on clinical research and apply only to people diagnosed with different types of mesothelioma cancer. These statistics don’t reflect other surgery stats for the population at large.

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Mesothelioma Surgery Benefits and Complications

Mesothelioma surgery can extend survival and relieve symptoms in eligible patients. Pleural surgery reduces chest pain and improves breathing. Peritoneal surgery relieves abdominal pain, swelling and digestive symptoms like constipation. In select cases, surgery offers the potential for long-term survival. 

It’s important for surgical candidates to discuss the risks and benefits of different procedures with their surgeons. The most common complications of mesothelioma surgery are pain and swelling around the incision and air leaking. The risks vary by the type of surgery and the patient’s health. Addressing complications quickly is important throughout the recovery process.

Mesothelioma Surgery Complications

• Air leaking
• Bleeding
• Cardiac complications
• Dry cough
• Fatigue
• Infection
• Pain after surgery
• Pneumonia

More than a decade after her mesothelioma surgery, Susan Dickman tells us the benefits were worth it. She developed an infection 6 weeks after, but it was her only complication. 

Susan says, “My husband helped me and my kids. God, all of them helped and got me back to normal.” She says she doesn’t have any lingering side effects and hasn’t had a cancer recurrence. 

What Recovery Looks Like After Mesothelioma Surgery

Everyone has a different mesothelioma surgery recovery process, depending on the surgery they’ve had, their overall health and whether any complications arise. Recovery timelines vary by procedure: P/D typically takes 3 to 4 months, while more aggressive surgeries like EPP and HIPEC can take longer. As Dr. Jacques Fontaine told us, EPP “is a tough recuperation that can take 3 to 6 months.” 

The recovery process also varies for people who undergo chemo or radiation after surgery. Doctors often tailor multimodal therapy plans. Some people may receive additional therapies soon after surgery, while others may need several weeks of recovery. 

For patients who undergo major pleural surgery, particularly EPP, pulmonary rehabilitation typically begins in the hospital before discharge. These supervised breathing exercises help rebuild lung capacity and reduce the risk of post-operative pneumonia. After returning home, many patients continue outpatient pulmonary rehab for several months, alongside physical therapy to rebuild strength and restore normal activity.

Tips for Managing Recovery After Mesothelioma Surgery

1. Take your medicine: Always take your pain medicine as your doctor says. This will help you feel better and rest more.
2. Get plenty of rest: Your body needs time to heal. Take naps and pace yourself.
3. Do breathing exercises: Use your breathing tool or take deep breaths every day. This helps your lungs get stronger and prevents infections.
4. Eat healthy foods: Try to eat fruits, vegetables and lean protein like chicken or eggs. Good food helps your body heal faster.
5. Move a little each day: Take short walks or move around a bit when your doctor says it’s safe. This helps with energy and keeps your blood moving.
6. Tell your doctor about new problems: If you feel worse or have trouble breathing, tell your care team right away. They can help.

Your surgical team will provide guidance to help you prepare for recovery at home. Most surgical teams typically schedule CT scans every 3 months for the first 2 years after surgery, then every 6 months through year 5. These scans help your care team detect recurrence early, when additional treatment options are most effective.

Your oncologist will also monitor blood markers and symptoms at each visit. If imaging shows signs of recurrence, your team may recommend chemotherapy, immunotherapy or additional surgery depending on where the cancer has returned and your overall health.

Survivor Story

Kim Madril: What did the recovery process look like after surgery?

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In terms of my recovery, I realized the importance of eating well, getting rest, exercising, positive thoughts, emotional sort of grounding, the value of family and friends and support, and also education, the resources that are currently available for mesothelioma patients.

That had a lot of value too. Some of the home treatments was this sort of cupping thing, which is really uncomfortable.

And there’s some, like, ancient anecdotes that it does help this whole cupping thing, percussion and cupping. I mean, you know, there’s sort of holistic component to it and also medical. And so that was part of his protocol as I had to do this cupping thing. Somebody had to sort of pound my back. It was horrible. Then I had to, lean over a table and do sort of deep breathing.

I hated that, but it was to expand my lung. There was some value to it. Now the physician was Kim. This is why you do the cupping so that you don’t develop too many secretions. You gotta get it out, not to be disgusting, but you’ve gotta, like, you know, cough it up, expectorate, the phlegm.

And then you have to stretch out your lung, and that’s the purpose of this whole stretching thing, and then you’ve gotta walk because you wanna you don’t wanna develop, like, a blood clot. You wanna keep your body active. So I did all that. And I didn’t wanna go outside, so I would walk around and around my mom’s kitchen and sort of her living room. And it was probably about five weeks And that was the time that doctor Cameron said, okay, at about five weeks, that’s when we wanna start the radiation. Probably, Kim, in about three months, you can go back to work.

Or or depending on how radiation goes, some people get symptomatic. Some people will end up with the whole nausea thing.

Sometimes they’re skin issues. Yeah.

And so it depends on a comfort level as well.

But I think probably three to six months you can go back to work. But generally, it takes about a year to recover after the surgery, the symptoms will get less and less. The pain will get less and less.

Next Steps if You’re Considering Mesothelioma Surgery

Before undergoing surgery for mesothelioma, talk to your surgeon to make sure you understand the risks and benefits of the procedure. Ask questions about how the procedure may affect your body, quality of life and lifespan to make an informed decision about mesothelioma surgery.

List title: Questions to Ask Your Doctor

• What surgical option is best for me?
• What are the benefits of this procedure?
• What risks could I face if I choose to have this surgery?
• What can I do to reduce my risks of complications?
• How can I best prepare for surgery and recovery?

Prepare for surgery following your surgical team’s guidelines. Planning for the recovery process involves building a strong support team at home and making sure your caregivers are prepared to help. Talk to your doctors about follow-up appointments to see if your surgery was successful.

Mesothelioma survivor Michael Cole tells us his caregivers got him through the first phase of recovery. He shares, “You will be largely dependent upon your caregivers at home for several weeks after surgery. The situation will improve, and after a few weeks, you will be able to carry more of the load yourself.” 

Michael adds. “With time, it is possible to recover most of one’s abilities, although with a few limitations. Don’t lose hope and never give up!”

Common Questions About Surgery for Mesothelioma

What is the survival rate after mesothelioma surgery?

Survival rates after mesothelioma surgery vary by cancer type, stage and procedure. About 24% of early-stage pleural mesothelioma patients live at least 5 years after surgery. A 2024 analysis found the P/D group had 10-year overall survival rates of 16%, significantly higher than any other surgical group. Peritoneal mesothelioma patients have more favorable outcomes. About 50% to 69% of those who undergo cytoreductive surgery with HIPEC live longer than 5 years, with some living 10 years or more. These statistics reflect clinical research and vary based on individual health factors.

Can mesothelioma be removed with surgery?

Yes, aggressive surgeries attempt to remove early-stage mesothelioma completely, but some microscopic cancer cells are often left behind. Chemotherapy and radiation may help to kill the remaining cancer cells.

How successful is surgery for mesothelioma?

About 24% of early-stage mesothelioma patients live at least 5 years after surgery. An EPP and P/D have a risk of failure with mortality rates around 11% and 3.1%, respectively.

How long is the recovery from mesothelioma surgery?

Most patients stay in the hospital for about a week, with full recovery taking several weeks to a few months. Recovery depends on the type of surgery and your overall health. Pain, fatigue and breathing difficulty are common but manageable with support.

Is there an age limit for mesothelioma surgery?

There’s no strict age limit for surgery. While age can be a factor in deciding eligibility, your doctor will consider your overall health, not just your age. People of all ages can successfully undergo surgery if they’re able to tolerate surgery and recovery.

What happens if I’m not eligible for surgery?

Several other treatment options are available to help manage mesothelioma and improve quality of life. These include chemo to kill or slow the growth of cancer cells; immunotherapy to boost your body’s ability to fight cancer; and radiation therapy to shrink tumors and relieve symptoms. 

Emerging treatments such as gene therapy, targeted therapies and clinical trials of new drugs may also provide additional options. Additionally, palliative care manages symptoms like pain and includes procedures like fluid drainage to ease breathing difficulties. Consulting with a mesothelioma specialist can help determine your best personalized treatment plan if surgery isn’t an option.