Based on Your Reading:
Get a Mesothelioma Treatment Guide
Find a Top Mesothelioma Doctor
Access Help Paying for Treatment
Mesothelioma surgery is a procedure in which a surgeon removes cancer from your body. The goal is to help you feel better and live longer. Aggressive surgery, in combination with chemotherapy and sometimes radiation, is considered the best treatment for mesothelioma because it offers the greatest chance of long-term survival.
Mesothelioma surgeons may recommend surgery to diagnose the disease, remove tumors or improve symptoms. Patients may have several surgical options that vary depending on the type of mesothelioma malignancy, cancer stage and the goal of the procedure.
Exclusive Content | Dr. Jeffrey Velotta: What is the typical timeline for mesothelioma surgery?
Not all mesothelioma patients are eligible for aggressive surgeries. However, most patients qualify for palliative surgery. It is less aggressive and can improve symptoms and quality of life. Before surgery, mesothelioma doctors assess each candidate to make sure they are healthy enough to undergo the procedure. Doctors examine lung and heart health with pulmonary function and cardiac stress tests.
Different surgical options are available at all mesothelioma stages. You may be eligible for surgery if your health is good and your doctor is confident you can recover from potential surgery complications. You may not qualify if the tumors have the sarcomatoid cell type or have spread too far. It is important to speak with a surgical specialist to determine if you meet the criteria.
Doctors vet eligibility for surgery during a surgical consultation. The surgical team reviews a patient’s medical history, imaging scans and biopsy results. Patients meet with the surgeon to discuss everything about the procedure.
Mesothelioma surgery is neither curative nor free of risks and side effects. It offers significant improvements in survival time, mesothelioma symptoms and quality of life. These procedures are complex. The nation’s top cancer centers offer them using the latest technologies such as robotic surgery.
Mesothelioma surgery is performed to diagnose disease, remove tumors (aggressive surgery or tumor-removing surgery) or improve symptoms (palliative surgery). Surgeons use more aggressive surgeries on people diagnosed in early stages of mesothelioma. About 15% to 20% of patients with pleural mesothelioma qualify for aggressive surgery.
The most aggressive surgeries for pleural mesothelioma include pleurectomy and decortication and extrapleural pneumonectomy. The most effective and aggressive surgery for peritoneal mesothelioma is a peritonectomy with heated chemotherapy, known as HIPEC. These surgeries may take several hours to complete and recovery time varies depending on the procedure.
Multimodal therapy combines major, tumor-removing surgery with other treatments. Other therapies include radiotherapy and chemotherapy. This aggressive treatment approach can extend life expectancy. Some cases have entered remission.
This aggressive surgery removes an entire lung, the lining around it and nearby lymph nodes. It also removes parts of the diaphragm and the lining around the heart, called the pericardium.
Theoretically, EPP offers the best chance to remove all cancer cells for people with pleural mesothelioma. Benefits include improved symptoms and survival. However, it is an intense procedure and permanently reduces the patient’s stamina and strength because an entire lung is removed. Other complications include abnormal heartbeat, blood clots and fluid buildup in the lungs.
A 2017 study at the Baylor Scott & White Medical Center in Temple, Texas, investigated the effect of a combination of EPP and intensity modulated radiation therapy on patients with pleural mesothelioma. The researchers reported a median survival of 38.2 months and a median relapse-free survival of 24.4 months.
P/D surgery was developed as a less aggressive alternative to removing an entire lung for pleural mesothelioma patients. Surgeons remove the pleural lining around the lungs and all visible tumors. They scrape the surface of the diseased lung rather than removing the organ.
A benefit to this procedure is keeping the affected lung. Approximately 90% of patients experience reduced symptoms. Risks include prolonged air leak, infection, excessive bleeding, cardiac complications and respiratory failure. P/D and EPP offer similar survival outcomes. EPP has a median overall survival of 12 to 22 months compared with 13 to 29 months for P/D.
A partial pleurectomy, sometimes called debulking, aims to remove as much tumor tissue as possible when the tumor cannot be completely removed. Pleural mesothelioma patients in otherwise good health may be eligible for this procedure.
A partial pleurectomy involves opening the chest cavity and removing the outside of the pleural layer that lines the chest wall and lungs. It treats mesothelioma by removing all visible cancerous tissue.
Complications that may occur with a partial pleurectomy include air leak, bleeding, cardiac issues, infection, pneumonia, respiratory failure and post-operative pain. A pleurectomy has a risk of failure with a mortality rate around 3.1%.
Typically, surgery is more successful as a mesothelioma treatment option in the early stages when cancer has not yet metastasized to distant sites in the body. Surgeons use aggressive surgery in the early stages for this reason.
While palliative surgeries are less aggressive procedures, they still carry risks. Mesothelioma surgeries are difficult procedures to undergo, but they offer the best chances of improving a patient’s quality of life and prognosis.
Pleural mesothelioma has the most surgical options, but these procedures are less effective than surgeries for peritoneal patients. These surgeries can be matched to best meet the patient’s needs and treatment goals. The following palliative surgeries help control symptoms for people with late-stage mesothelioma, and some people live longer thanks to these procedures.
Nearly 40% of peritoneal mesothelioma patients qualify for tumor-removing surgery. The most effective treatment for this disease combines a peritonectomy with HIPEC.
A patient’s Peritoneal Cancer Index score, which measures how far cancer has progressed, can predict how well they will respond to surgery. According to a 2020 study published in Scientific Reports, patients with a low score respond best to surgery.
Pericardial and testicular mesothelioma are the rarest forms of the cancer, accounting for less than 2% of cases combined. Surgeries for these conditions have varying success rates, and surgeries involving the heart tend to have higher risks of serious complications. Survival rates are higher among testicular patients compared to pericardial patients.
Get a Mesothelioma Treatment Guide
Find a Top Mesothelioma Doctor
Access Help Paying for Treatment
Benefits of mesothelioma surgery include longer survival and improved symptoms. Pleural surgery reduces chest pain, improves breathing and cough. Peritoneal surgery improves abdominal pain and swelling plus digestive symptoms such as constipation. Robotic mesothelioma surgery benefits include reduced blood loss, pain and recovery time.
Risks of mesothelioma surgery include pain, numbness or burning, infection, excessive bleeding, cardiac complications and respiratory failure. Peritoneal surgery risks also include digestive issues, excessive bleeding and constipation.
Aggressive surgery can potentially remove mesothelioma completely. But there’s a risk that some cancer cells get left behind, which can grow and divide to later form new tumors. Chemotherapy is used in conjunction with surgery to eliminate many remaining cancer cells to prolong survival.
It’s important for surgical candidates to speak with their surgeon about the risks and benefits of different procedures. For example, a study published in 2014 reported a significantly higher mortality rate for patients who underwent the more radical EPP procedure compared to those who underwent the less invasive P/D procedure. The study reported a mortality rate of 10.5% for EPP and only 3.1% for P/D. Additionally, the morbidity rate, or complication rate, for EPP was 24.2%, whereas P/D had a morbidity rate of only 3.8%.
The most common side effects of mesothelioma surgery are pain and swelling around the incision. This usually gets better over time, but it depends on the extent of the surgery.
If you have any questions about these or other symptoms or feel they are worse than they should be, call your doctor right away.
Each patient experiences a different recovery process depending on the surgery they had, their overall health and whether any complications arise. How long it takes to recover and the amount of pain you feel will depend on the extent of the surgery.
Your surgeon can help you develop a recovery and pain management plan to cope with the discomfort you experience after surgery. Before you leave the hospital, your doctor will provide a prescription for oral pain medication and your surgical team will provide guidance on the recovery process.
Some surgeries offer an easier recovery. After robotic surgery proved its effectiveness for other minimally invasive procedures, doctors began using it for chest cancer surgeries in 2006. In 2013, Dr. Farid Gharagozloo performed the first robotic extrapleural pneumonectomy for a pleural mesothelioma patient. Benefits of robotic surgery include reduced blood loss, less pain, reduced postoperative recovery time and less stress on the remaining lung after an EPP procedure.
The recovery process varies for people who undergo chemotherapy or radiation therapy after surgery. Doctors often tailor multimodal therapy plans around each patient’s health. Some patients may receive additional therapies soon after surgery, while other patients may require several weeks of recovery.
The type of surgery your doctor recommends will depend on the stage of mesothelioma, cell type and the goal of the procedure. Mesothelioma surgeries, which are complex and not risk-free, can offer significant improvements in survival time, mesothelioma symptoms and quality of life.
Your surgical team will provide guidance to help you understand how to prepare for the recovery process at home. They’ll also schedule follow-up appointments for imaging scans to observe the outcome of the surgery.
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 optimal therapies to combine with surgery.
Mesothelioma surgery can be a challenging and emotionally taxing experience for the patient and their loved ones. The recovery process may take weeks to months. Your loved one with mesothelioma may feel anxious, scared or overwhelmed about surgery. Caregivers, family and friends can provide emotional support, listen to concerns and offer encouragement and positivity. Remind them that they are not alone on this journey.
After surgery, the patient may need help with everyday tasks such as cooking, cleaning and running errands. Recovery from mesothelioma surgery can take time, and it is important to be patient and understanding. By offering this kind of support, you can help your loved one through this challenging time and boost their chances of a good recovery.
We will help you find the best mesothelioma doctor in your area. Our Patient Advocates have relationships with top doctors and cancer centers and can help you schedule and expedite appointments.