The most common surgery for mesothelioma is extrapleural pneumonectomy (EPP), which involves removal of the lung, lung lining (pleura), diaphragm, and nearby tissue. Different surgeries may be employed depending on mesothelioma type, stage, and other factors.
Key Points about Mesothelioma Surgery
- Surgery is one of the most common types of treatment for mesothelioma.
- The goal of potentially curative surgery is to remove as much of the cancer as possible.
- Palliative surgery attempts to relieve pain and discomfort in mesothelioma patients.
- Some surgical methods are also used to diagnose mesothelioma.
The most effective mesothelioma treatments typically involve surgery combined with chemotherapy and/or radiation. Surgery can be performed in an attempt to remove the cancer completely, or it can be performed as a part of palliative care to reduce pain and discomfort.
Most Common Surgeries by Mesothelioma Type
Extrapleural Pneumonectomy (EPP) – Removal of an entire lung, part of the diaphragm, the lung linings (pleura), and the covering over the heart.
Pleurectomy/Decortication (P/D) – Removal of the pleura around the affected lung and any visible tumors.
Cytoreduction with HIPEC – Removal of the lining of the abdomen (peritoneum), along with visible tumors, and uses a heated chemotherapy wash to kill leftover cancer cells.
Pericardiectomy – Removal of some or all of the fibrous tissue around the heart (pericardium).
How Surgery Treats Mesothelioma
The primary goal of surgery is used to remove as much of the mesothelioma as possible. Other treatment options used before or after surgery – such as chemotherapy, radiation, and immunotherapy – assist surgical goals by reducing the size of tumors and killing cancer cells.
Surgery options available to mesothelioma patients depend on several factors, including:
- Patient age and health – Younger, healthier patients tend to be able to handle mesothelioma surgery better than older or unhealthy individuals.
- Mesothelioma type – Where tumors are located in the body will determine which types of surgery may be needed.
- Stage at diagnosis – Surgery is often less effective in late stages (Stage 3 and Stage 4) of mesothelioma, as the disease starts to spread.
Given the rarity and complexity of mesothelioma, it is important to see a specialist with experience treating this disease.
- Pleural or pericardial mesothelioma: Patients are referred to a thoracic surgeon, who specializes in surgery involving the heart, lungs, and other areas of the chest.
- Peritoneal mesothelioma: Patients are referred to a gastrointestinal surgeon, who specializes in abdominal surgery.
Other specialists may be called in to assist with the surgery, depending on the complexity of the operation and the individual patient’s needs.
Mesothelioma Surgery Risks and Side Effects
As with any surgery, there are risks and side effects associated with mesothelioma surgery. Your surgeon, other doctors, and medical staff will do their best to prevent these complications; however, there is a certain level of risk with every surgery.
- Pain at incision site
- Swelling, drainage, or infection
- Heart complications
- Low blood pressure
- Air leakage
- Deep vein thrombosis (clotting)
- Pulmonary aspiration
- Temporary bowel paralysis
- Kidney failure
Surgical Approaches to Mesothelioma
Generally, mesothelioma surgeries are divided into three categories: diagnostic, potentially curative.
Surgery may be required as part of the diagnostic process. This usually includes a biopsy, in which tissue is removed for analysis by a technician to determine presence, type, and stage of the cancer.
Thoracotomy – Surgery that permits access to the lungs and heart. Typically performed before a pleurectomy/decortication or extrapleural pneumonectomy to determine whether the cancer is operable.
Thoracoscopy – A minimally invasive diagnostic surgery used to look for signs of mesothelioma on the pleura or surface of the lungs, including inflammation, pleural plaques, thickening, or abnormal growths.
Mediastinoscopy – Similar to a thoracoscopy; however, a tube is inserted through an incision in the neck instead of the chest.
Laparotomy – An aggressive procedure that requires a large incision, used when a large biopsy sample is needed. A surgeon may attempt to remove tumors altogether during a laparotomy.
Laparoscopy – A minimally invasive surgery that lets surgeons view the abdominal lining to see if there are tumors or cancerous cells in the tissue or surrounding peritoneal tissue.
Potentially Curative Surgery
A surgery is potentially “curative” when the goal is to remove all or most of the cancer from the body, significantly improving a mesothelioma patient’s prognosis. As an aggressive treatment option, this approach is usually pursued only in early stages of the disease and when the patient is in good overall health.
The survival rate for mesothelioma patients is higher when surgery is combined with other cancer treatments, such as chemotherapy and radiation therapy (an approach known as multimodal treatment). As such, multimodal treatment that includes potentially curative surgery has become the most common form of mesothelioma treatment in patients with resectable tumors.
Palliative surgery helps relieve painful side effects and symptoms of mesothelioma, effectively improving a patient’s quality of life. Palliative care can be performed in addition to potentially curative treatments, and it can also be used in cases where patients are terminally ill to help ease their discomfort.
The most common type of palliative surgery for mesothelioma is the removal of fluid from around the lungs, abdomen, or heart. This is accomplished through one of several procedures.
Pleurodesis – A procedure to make the outside of the lungs adhere to the the chest wall to prevent fluid from accumulating. According to the American Cancer Society, this procedure has a 90% success rate in eliminating or reducing fluid buildup.
Pericardiocentesis – Removal of fluid from around the heart (pericardial effusion) by use of a needle, which relieves pressure on the heart and can prevent a heart attack. It can also be used as a diagnostic procedure.
Thoracentesis – Removal of abnormal fluid buildup in the lungs (pleural effusion) by use of a needle, which eases pressure on the lungs and makes it easier for the patient to breathe. It can also be used as a diagnostic procedure to obtain fluid for analysis.
Paracentesis – Removal of fluid in the abdominal cavity (peritoneal effusion) by use of a needle, which eases pressure on the abdominal cavity and organs. It can also be used as a diagnostic procedure.
Mesothelioma Surgery Costs
The cost of mesothelioma treatment can be astronomical, and surgeries contribute greatly to those expenses. In addition to the procedure itself, costs related to surgery can include:
- Postoperative care
- Hospital room costs
- Follow-up visits
- Travel to/from cancer centers
These costs are all in addition to day-to-day living expenses, which may already be difficult to meet on a fixed income – especially if you are unable to work due to your mesothelioma diagnosis. If you have difficulty knowing how to pay for mesothelioma surgery and other treatments, help may be available.