Mesothelioma Surgery

Different surgeries may be employed depending on mesothelioma type, stage, and other factors. Surgeries may be curative, palliative or used as a diagnostic tool.

Key Points

  • 1

    Surgery is one of the most common types of treatment for mesothelioma.

  • 2

    The goal of potentially curative surgery is to remove as much of the cancer as possible.

  • 3

    Palliative surgery attempts to relieve pain and discomfort in mesothelioma patients.

  • 4

    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,  as a part of palliative care to reduce pain and discomfort, or as a diagnostic effort such as a biopsy. For patients diagnosed at an early stage, surgery is most often recommended as part of a curative treatment plan. Mesothelioma patients with late stage mesothelioma typically only have palliative treatment options because the cancer is too widespread in the body.

Most Common Surgeries by Mesothelioma Type
Pleural Mesothelioma

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) – Two-part surgery that entails removal of the pleura around the affected lung and any visible tumors.

Peritoneal Mesothelioma

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. There have been great improvements in peritoneal mesothelioma survival rates because of the success of this multimodal treatment.

Pericardial Mesothelioma

Pericardiectomy – Removal of some or all of the fibrous tissue around the heart (pericardium). The majority of other pericardial surgeries utilized are considered more palliative, as they focus on removing fluid buildup (pericardial effusion) to relieve symptoms and improve heart function.

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 is not an option for all mesothelioma patients. There are a number of factors that can influence whether or not a patient is eligible.

Factors Impacting Surgical Options
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. Mesothelioma cell type can also impact if surgery is an option.

Stage at Diagnosis

Surgery is often less effective in late stages (stage 3 and stage 4) of mesothelioma, as the disease starts to spread.

Mesothelioma Surgeons

Given the rarity and complexity of mesothelioma, it is important to see a specialist with experience treating this disease. Depending on the type of mesothelioma, patients may be referred to different types of surgeons.

Surgeons By Mesothelioma Type
Pleural and 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 typically 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.

Find a Mesothelioma Doctor Near You

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.

Mesothelioma Surgery Side Effects
Common Complications
  • Pain at incision site
  • Swelling, drainage, or infection
  • Bleeding
  • Fatigue
  • Heart complications
  • Low blood pressure
Rare Complications
  • Hemorrhage
  • 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 and palliative. Each category has several surgical options, which are largely dependent on the type of mesothelioma.

Diagnostic Surgery

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. A biopsy or other diagnostic surgery often isn’t performed until after a doctor has analyzed other diagnostic tests, like imaging scans.

Diagnostic Surgeries for Pleural and Pericardial Mesothelioma
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

A minimally-invasive surgery performed similarly to a thoracoscopy with the same intent of finding signs of mesothelioma; however, a tube is inserted through an incision in the neck instead of the chest.

Since peritoneal mesothelioma is in the abdomen, it requires different diagnostic surgeries than the other forms of mesothelioma which develop in the same general region of the body.

Diagnostic Surgeries for Peritoneal Mesothelioma
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

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.

Palliative Mesothelioma Surgeries
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, mesothelioma patients will typically see additional treatment costs.

Additional Mesothelioma Treatment Costs
  • Anesthesia
  • Postoperative care
  • Prescriptions
  • Hospital room costs
  • Follow-up visits
  • Travel to 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.

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