Mesothelioma Surgery

Surgery is used to diagnose and treat mesothelioma. Minor surgeries diagnose the asbestos-related cancer and control its symptoms. Major surgeries aim to remove tumors and improve long-term survival. A mesothelioma specialist can recommend which surgeries are best for your unique case.

Major surgery offers the greatest chance of long-term survival with mesothelioma. 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.

Around 15 to 20 percent of people with pleural mesothelioma qualify for tumor-removing surgery, while nearly 40 percent of peritoneal mesothelioma patients qualify.

Before discussing surgery as an option, doctors will want to make sure your body is strong enough to recover. They will determine your lung and heart health by conducting a pulmonary function test and running cardiac tests such as an electrocardiogram (EKG), stress test, angiogram or 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 can help people live for years with mesothelioma.

Many of the survivors on our Wall of Hope opted for surgeries that gave them more years to spend with children and grandchildren.

Three Different Purposes of Mesothelioma Surgery

Sometimes, major surgery is not an option, but other procedures are. Surgeries for patients of pleural and peritoneal mesothelioma generally fall into three categories: Tumor removal, palliative and diagnostic. Choosing what type of mesothelioma surgery to have is up to you and your specialist.

Tumor-removing surgeries require an experienced mesothelioma surgeon; palliative surgeries are less-invasive and help relieve pain; and diagnostic surgeries are the third option for when you and your specialist need to find out more about your particular disease.

Pleural Mesothelioma Surgery

Doctors primarily use two different tumor-removing surgeries for pleural mesothelioma: Extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D).

Palliative surgeries include thoracentesis and pleurodesis. Both aim to control fluid buildup. The primary diagnostic procedure is a thoracoscopy, which uses a camera to locate potentially cancerous tissue for biopsy testing.

Pneumonectomy

A pneumonectomy involves removing a lung. The procedure usually includes the removal of the lining around the lung. A patient may qualify for this surgery if cancer hasn't spread beyond one lung. However, most surgeons perform the more extensive EPP surgery if they’re going to remove the lung.

Learn more about pneumonectomy

Thoracotomy

Thoracotomy is a general term for a surgery that allows doctors to access a patient’s lungs, heart, aorta, trachea or diaphragm. The incision, typically between 4 and 10 inches in length, can be made on either side of the chest.

While surgeons generally opt for a minimally invasive thoracoscopy to perform biopsies and remove small lung cancer tumors, more extensive procedures require a thoracotomy. Mesothelioma surgeons perform a thoracotomy before completing a pleurectomy/decortication and extrapleural pneumonectomy, two leading surgical options for the management of pleural mesothelioma. This procedure is also the first step of several asbestos-related lung cancer surgeries such as pneumonectomy, lobectomy, wedge resection and segmentectomy.

Even with the latest advances in imaging technology and other diagnostic techniques, up to 25 percent of mesothelioma patients cleared for surgery are inoperable after a thoracotomy. If surgeons realize the planned surgery is impossible after directly viewing a patient’s lungs, they may use the opportunity to stage the extent of disease and guide the patient’s options for nonsurgical therapy.

The average hospital stay after thoracotomy is five to 10 days. Because of irritation to nerve endings near the incision, you will likely experience pain, numbness or burning below your breast and at the front of your rib cage.

Drainage of a clear or pink fluid from the incision is normal. You should clean your incision in the shower, washing gently with warm water and a mild soap. Avoid submerging the incision in a bathtub or spa for three weeks. It is important that you avoid heavy lifting and other strenuous activities for six to eight weeks because they could put stress on your incision and delay recovery. You should perform breathing exercises and walk every day to help improve your strength, circulation and lung capacity.

Peritoneal Mesothelioma Surgery

The tumor removing option for someone with peritoneal mesothelioma is cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC). This aggressive surgery takes hours to complete and gives patients the greatest chance of long-term survival with peritoneal mesothelioma.

Palliative surgery includes a paracentesis, which removes excess fluid from around the abdomen to relieve pressure and pain. This procedure is also used for diagnostic purposes because the fluid is examined for signs of cancer.

Peritonectomy and Cytoreductive Surgery

A peritonectomy removes cancerous tissue from the abdomen with a cytoreductive approach. Cytoreductive surgery is often referred to as debulking surgery, and it involves removing as much of the cancerous growth as possible from inside the abdominal cavity, including removal of parts of the liver, pancreas, spleen, gall bladder, bowels and stomach.

Like the pleurectomy/decortication, it is detailed surgery that can take several hours to complete. After cytoreductive surgery, doctors usually perform the HIPEC procedure, which is a process of heating chemotherapy drugs and delivering them directly to the abdomen.

Paracentesis

Paracentesis is a surgical procedure in which a needle is inserted into the peritoneal cavity — the space between the two membranes that separate the organs in the abdominal cavity from the abdominal wall — in order to remove excess peritoneal fluid, also known as ascitic fluid. This procedure, which is sometimes called an abdominal or ascites tap, may be used for diagnostic or therapeutic purposes.

Patients with peritoneal mesothelioma-induced ascites might undergo a paracentesis to help verify the diagnosis, or more often, to alleviate stomach pain or difficulty breathing because of increased abdominal pressure caused by excessive fluid buildup.

A paracentesis is a minor surgery and first-line treatment option that can improve the quality of life for a person with peritoneal mesothelioma. Because ascites often reoccur with peritoneal mesothelioma, repeated therapeutic paracenteses can be administered as palliative care in patients with advanced stages of this disease.

Pericardial Mesothelioma Surgery

The only tumor-removing surgery available for pericardial mesothelioma is a pericardiectomy. It removes as much cancerous tissue as possible from the heart lining. It can help with difficulty breathing, chest pain, heart palpitations and fatigue. The surgery can also relieve pericarditis (inflammation of the pericardium) and pericardial effusion (buildup of fluid in the pericardium). It’s important to treat these conditions early, before they cause deadly complications.

A pericardiocentesis is a palliative and diagnostic procedure. It removes excess fluid from the heart lining and that fluid is tested for signs of cancer. The buildup of fluid in the heart lining can cause painful pressure on the heart, chest pain, dyspnea (shortness of breath) and coughing. This procedure can effectively remove fluid buildup to relieve these symptoms.

A pericardial mesothelioma diagnosis cannot be confirmed with diagnostic testing of pericardial fluid because the fluid rarely contains malignant cells when mesothelioma is present.

Risks, Complications and Side Effects

The most common side effects of mesothelioma surgeries are pain, swelling or infection at the incision site.

Whenever a foreign object, such as a needle, knife or tube, is placed into the body, swelling and drainage usually occur. In fact, open drainage is recommended during the healing process.

Mild swelling, draining and bruising of the injured tissues are typical and will usually resolve themselves on their own within a few days or weeks.

If any of these symptoms occur in excess, you should contact your doctor. Excessive inflammation or foul-smelling drainage at the surgery site may be a sign of infection. Other signs of infection include redness and a warm or tingling sensation. Postoperative infection should be controlled under a doctor's care, but it is imperative to report it immediately to prevent the infection from becoming fatal.

• Bleeding: Most patients will experience minimal bleeding that poses no threat to overall health, and the body will be able to regenerate any blood that has been lost. During recovery, overstretching or otherwise damaging the incision area can result in bleeding. If bleeding becomes extensive, seek immediate medical attention.

• Fatigue: Even after any anesthesia wears off, patients may still feel fatigued from the basic bodily stress that occurs with an invasive procedure, especially a major operation such as EPP or P/D. The fatigue may be intensified if the patient does not eat enough food or get enough rest to restore the body's energy levels.

• Cardiac complications: Mesothelioma surgeries performed in the chest cavity pose the risk of causing cardiac complications. The most common risk is atrial fibrillation or cardiac arrhythmia (irregular or abnormal heart beat).

Less radical surgeries, such as a pleurodesis or thoracotomy, are typically associated with minor side effects.

Managing Pain After Surgery

Discomfort after mesothelioma surgery may be dull and tingling or more intense. For some patients, the pain will occur when they stand, sit, walk or try to perform daily activities. But for others, the pain may occur even at rest.

Your surgeon can help you develop a pain management plan to cope with the discomfort you might experience after surgery. Before you leave the hospital, your doctor will most likely provide prescriptions for general nerve blockers or oral pain relievers. These can include prescriptions for narcotics, such as morphine, for severe pain or Vicodin for moderate pain.

Over-the counter (OTC) medications, such as acetaminophen (Tylenol), ibuprofen (Advil) or naproxen (Aleve), may be recommended to relieve mild pain.

Any OTC medications should not be taken after surgery without specific instructions from your doctor.

Who Are the Top 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.

Pleural Mesothelioma Surgeons

Peritoneal Mesothelioma Surgeons

Peritoneal mesothelioma surgeons are located throughout the country. If you’ve been diagnosed with this cancer you should consider seeking a second opinion from a peritoneal mesothelioma specialist.

Pericardial Mesothelioma Surgeons

Heart surgeons, known as cardiac surgeons, are the physicians who perform pericardiectomies. Patients should ask how many of these procedures a surgeon has performed to gauge the experience level of the physician.

Certain hospitals perform more of these surgeries than others. For example, surgeons at Cleveland Clinic follow the guidance of Dr. Allan Klein, director of the hospital's Center for the Diagnosis and Treatment of Pericardial Diseases.

Meanwhile, Dr. Jae K. Oh, the director of cardiac imaging and the pericardial disease clinic at Mayo Clinic in Rochester, is instrumental in pericardial mesothelioma surgeries performed there.

Future of Mesothelioma Surgery

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 2006, doctors began using it for chest cancer surgeries.

Dr. Farid Gharagozloo, currently at Florida Hospital Celebration Health, 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 attached to a robotic arm. Robotic surgery shortens recovery time because it significantly reduces blood loss. It also lowers the stress on the remaining lung, which is often a major problem when the surgery is done conventionally.

As mesothelioma surgeons make advancements in procedures and techniques, clinical trials are investigating the best therapies to combine with surgery. This research is slowly improving mesothelioma survival rates.

For example, it wasn’t long ago that nearly everyone diagnosed with peritoneal mesothelioma lived around six months. Today, nearly half of peritoneal patients who receive HIPEC live beyond five years.