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

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

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

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.

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.

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.

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.

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.

David Sugarbaker, M.D.

Thoracic Surgery

Baylor College of Medicine

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Robert B. Cameron, M.D.

VA Greater Los Angeles Healthcare System

UCLA Medical Center

E-consultation available

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Rodney Landreneau, M.D.

Thoracic Surgery

Ochsner Cancer Institute

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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.