Written By: Karen Ritter, RN BSN
Mesothelioma Surgery
Mesothelioma surgery is a type of mesothelioma treatment to remove most or all of the patient’s tumors. Surgery for mesothelioma may involve removing affected organs, such as a lung. Successful surgery can significantly improve survival for patients who recover well.
Medically Reviewed By
Dr. Hassan Khalil
Mesothelioma Thoracic Surgeon
Medically Reviewed By
Dr. Hassan Khalil
Mesothelioma Thoracic Surgeon
JUMP TO A TOPIC
Important Facts About Mesothelioma Surgery
- There are two surgery options for pleural mesothelioma, which forms in the linings around the lungs. There is one surgery for peritoneal mesothelioma, which forms in the lining of the abdominal cavity.
- Each surgery has a unique recovery process, and each patient responds differently to an aggressive operation.
- There are surgeons at the top cancer centers who have experience successfully performing mesothelioma surgery.
- There are many survival stories of people who beat their mesothelioma cancer thanks to surgery.
What is Mesothelioma Surgery?
Mesothelioma surgery is a medical procedure to remove mesothelioma tumors from the patient’s body. Mesothelioma is a cancer that forms in the mesothelial tissue linings, which surround the lungs, abdominal cavity and heart. Surgery to remove the diseased linings and any nearby tissue or organs can eliminate mesothelioma tumors.
Surgery is the first option considered for people diagnosed with mesothelioma. Doctors determine eligibility based on the stage of the cancer, whether the disease has affected vital organs, and the patient’s overall health.
Types of Surgery for Mesothelioma
The types of surgery for mesothelioma are:
- Diagnostic surgery – Minimally invasive surgery to remove a tissue sample to test for the presence of cancer
- Aggressive surgery – Intended to remove all visible tumors and potentially eliminate the entire cancer
- Palliative surgery – Intended to improve quality of life by removing tumors or fluid that can cause side effects, such as pressure against the chest
Top Mesothelioma Surgery Options
The top mesothelioma surgery options are:
- Pleurectomy/decortication (pleural mesothelioma)
- Extrapleural pneumonectomy (pleural mesothelioma)
- Cytoreduction with HIPEC (peritoneal mesothelioma)
These surgeries are aggressive treatment options and intended to remove all visible tumors and diseased tissue. The hope is patients will have fewer tumors – if any – following the operation and can enjoy an extended survival.
Each surgery is used for one of the two main types of mesothelioma: pleural mesothelioma (forms in the lining of the lungs) and peritoneal mesothelioma (forms in the lining of the abdominal cavity).
There are two other types of mesothelioma: pericardial mesothelioma (forms in the lining of the heart) and testicular mesothelioma. Below is information on surgery for each:
- Pericardiectomy – Used for pericardial mesothelioma, removes the lining around the heart
- Inguinal orchiectomy – Used for testicular mesothelioma, removes one or both testicles, the lining around the testes, and the spermatic cord
Pericardial mesothelioma and testicular mesothelioma account for just 1% of all mesothelioma cases.
Pleurectomy/Decortication Surgery for Pleural Mesothelioma
Pleurectomy/decortication (P/D) surgery for pleural mesothelioma is an aggressive mesothelioma surgery. This operation is a “lung-sparing” procedure that does not take out either lung.
Doctors remove the pleura, which is the lining of the lungs. This lining is where pleural mesothelioma forms. The medical team strips the pleura off of the lung to remove tumors that are in the lining and on the surface of the lung.
The mesothelioma doctors may need to also remove part or all of the diaphragm and pericardium (lining of the heart). Small pleural mesothelioma tumors or microscopic cancer cells may spread to these areas, and removal can prevent the disease from returning.
Extrapleural Pneumonectomy Surgery for Pleural Mesothelioma
Extrapleural pneumonectomy (EPP) surgery for pleural mesothelioma is an aggressive mesothelioma surgery. Doctors remove the entire lung affected by tumors. They also remove the lining of the lung (pleura), part of the diaphragm, and sac around the heart.
EPP was the first surgery used for pleural mesothelioma. It dates back to 1976, which is when the number of mesothelioma cases began rising in the United States. Mesothelioma has a latency period of 20-50 years.
Latency period is the time from asbestos exposure to the development of noticeable symptoms and eventual diagnosis. Mesothelioma, a rare cancer, was diagnosed more frequently in the second half of the 20th century due to an increase in asbestos exposure during World War II.
Patient selection is imperative for EPP surgery. Patients must be able to recover from lung-removal surgery and live afterward with just one lung.
Cytoreduction with HIPEC Surgery for Peritoneal Mesothelioma
Cytoreduction with HIPEC surgery for peritoneal mesothelioma is an aggressive mesothelioma surgery combined with chemotherapy. This is a “debulking” procedure where doctors remove all visible tumors and diseased tissue from the abdominal cavity.
Doctors may also remove:
- Spleen
- Gallbladder
- Omentum (fatty tissue layer in the abdomen)
- Peritoneum (lining of the abdominal cavity)
- Part of the large or small intestines
Once debulking is finished, doctors send heated chemotherapy into the abdominal cavity. The chemotherapy washes the cavity in cancer-killing drugs at a temperature above 100 degrees Fahrenheit. The chemotherapy circulates for 60-90 minutes before it is drained.
Palliative Mesothelioma Surgery
Palliative mesothelioma surgery is a type of treatment to reduce symptoms, such as fluid buildup in the lining around the lungs, abdomen or heart. Fluid buildup can cause pressure against the lungs or abdomen and creates discomfort for patients.
There are three palliative mesothelioma surgery options for the two main types of mesothelioma (pleural mesothelioma and peritoneal mesothelioma):
- Pleurodesis (pleural mesothelioma) – Pleurodesis closes the pleural space and limits fluid buildup in the pleura (pleural effusions).
- Thoracentesis (pleural mesothelioma) – This procedure drains fluid buildup in the lungs. Doctors use a needle to drain fluid, but they do not permanently close the pleural space.
- Paracentesis (peritoneal mesothelioma) – This procedure drains fluid from the abdomen. This fluid buildup is known as ascites.
There are two palliative surgeries for pericardial mesothelioma, which is only diagnosed a handful of times each year:
- Pericardiocentesis – This procedure drains fluid from the sac that lines the heart (pericardium). Doctors drain fluid from the pericardium with a needle.
- Pericardial window – During a minimally invasive procedure, a small incision is made in the pericardium. This procedure is used to relieve the pressure of fluid from around the heart.
Diagnostic Surgeries for Mesothelioma
Diagnostic surgeries are medical procedures to diagnose people with a specific disease. For cancer, these surgeries are called biopsies.
They involve removing a sample of tissue or fluid from the patient’s body. Doctors collect tissue from the area where they believe the cancer exists. For mesothelioma, these areas are the mesothelial linings around the lungs (pleura), abdominal cavity (peritoneum) or heart (pericardium).
Biopsy procedures to diagnose mesothelioma are:
- Thoracoscopy (pleural mesothelioma) – Endoscopic biopsy procedure with a small incision in the chest to take tissue from the pleura
- Mediastinoscopy (pleural mesothelioma) – Endoscopic biopsy procedure with an incision in the chest to take tissue from the mediastinum, which is the space between the two lungs, for evidence of mesothelioma metastasis and a late-stage diagnosis
- Thoracotomy (pleural mesothelioma) – Open surgical biopsy with a large incision in the chest to take tissue from the pleura
- Laparopy (peritoneal mesothelioma) – Endoscopic biopsy procedure with a small incision in the abdomen to take tissue from the peritoneum
- Laparotomy (peritoneal mesothelioma) – Open surgical biopsy with a large incision in the abdomen to take tissue from the peritoneum
Benefits and Risks of Aggressive Mesothelioma Surgery
Choosing whether to have mesothelioma surgery is an important decision. Patients should weigh their options, including the benefits and risks of an aggressive operation. This decision should be made with the guidance and recommendations of mesothelioma specialists.
Benefits include better chances of long-term survival and a healthier, cancer-free future. Risks include possible complications during or after surgery and the burden of living without a major organ (such as a lung).
“You don’t just leave it there,” says Gary Maxwell, a long-time mesothelioma survivor. “You take it out because it’d feel a lot better if you just got it out.”
Side Effects for Mesothelioma Surgery
The main side effects for mesothelioma surgery are pain, inflammation and soreness around the incision site, and general fatigue.
With the support of an experienced medical team, these side effects are manageable. Side effects may differ for every patient and with each type of surgery.
The main side effects from pleural mesothelioma surgery (P/D and EPP) are:
- Shortness of breath
- Chest pain
- Infection
- Air leaking from the lungs (pneumothorax)
The main side effects from peritoneal mesothelioma surgery (Cytoreduction with HIPEC) are:
- Abdominal pain
- Infection
- Bowel obstruction (small intestine or colon becomes blocked)
- Paralyzed bowel (food stops moving through the digestive system)
Mesothelioma Surgery Recovery Time
Mesothelioma surgery recovery time depends on the patient’s health, the type of surgery they have, and more factors. Recovery is important, as it allows your body an opportunity to heal.
Mesothelioma surgery recovery includes inpatient and outpatient rest, breathing exercises, light walking and physical therapy. It may also include mental health counseling.
Each surgery has a different expected recovery period, and patients react differently following surgery. Some patients may recover quicker than others, while some may need more time.
The average recovery time for each mesothelioma surgery:
- Extrapleural pneumonectomy – 2-3 months
- Pleurectomy/decortication – 1-2 months
- Cytoreduction with HIPEC – 2-3 months
Note: Most of the recovery time following mesothelioma surgery occurs in an outpatient setting, such as the patient’s home or a family member’s/caregiver’s home. Inpatient recovery time at the hospital usually only lasts 1-2 weeks.
Survival Rates After Mesothelioma Surgery
Survival rates after mesothelioma surgery depend on the type of surgery and type of mesothelioma. However, each mesothelioma surgery can improve survival if the procedure is successful and the patient recovers well.
There was a recent study of more than 250 people who had pleural mesothelioma surgery. They had either pleurectomy/decortication or extrapleural pneumonectomy. The average survival for the patients was 40.7 months (3 years, 4 months).
Below are a few more examples from studies that showcase patient survival following mesothelioma surgery.
- Pleurectomy/decortication – 114 women received extended pleurectomy/decortication at Brigham and Women’s Hospital and had a median survival of 38 months. Approximately 28% of them lived for at least 5 years.
- Extrapleural pneumonectomy – A study of more than 500 patients receiving extrapleural pneumonectomy had a median survival of 18 months (1.5 years). Approximately 14% of the patients lived for at least 5 years.
- Cytoreduction with HIPEC – From 1993-2001, more than 100 people with peritoneal mesothelioma received cytoreduction with HIPEC surgery at Wake Forest Baptist Health. The median survival was 40 months (3 years, 4 months).
Inspiring Mesothelioma Survival Stories Thanks to Surgery
There are several mesothelioma survival stories involving surgery. A medical procedure to remove tumors can lead to patient survival of 5-10 years, and sometimes more. Below are stories of people with mesothelioma who have benefited from surgery.
Gary Maxwell was 60 years old when he was diagnosed with malignant pleural mesothelioma. His original prognosis was 1-2 years. He underwent four rounds of chemotherapy followed by a pleurectomy/decortication surgery to remove the pleural lining and other diseased tissue. Gary has been in complete remission and cancer-free for nearly 10 years.
Alexis Kidd was 37 years old when she was diagnosed with peritoneal mesothelioma. She was originally diagnosed with stage 4 cancer but was downgraded to a stage eligible for surgery. She received cytoreduction with HIPEC surgery to remove visible tumors and have her diaphragm removed. Alexis has lived for more than 16 years since the surgery.
How to Get Surgery for Mesothelioma
Patients can get surgery for mesothelioma by following these steps:
- Contact Mesothelioma Guide patient advocates. Our team will match you with an experienced mesothelioma surgeon who specializes in your type of mesothelioma. Rely on our experts to find the best possible medical team so you have the best chance of a successful surgery.
- Research the surgery options for mesothelioma. Pleural mesothelioma patients should learn the difference between pleurectomy/decortication surgery and extrapleural pneumonectomy surgery. Peritoneal mesothelioma patients should research cytoreduction with HIPEC surgery. Learn what happens in each surgery, the possible side effects, and the recovery time.
- Prepare for your upcoming surgery. Candidates for surgery should focus on improving their nutrition and strengthening their body for the procedure and the recovery process.
Top Doctors and Cancer Centers for Mesothelioma Surgery
Below are a few of the top mesothelioma doctors who perform mesothelioma surgery.
- Dr. Hassan Khalil – Thoracic surgeon in Boston, MA, specializing in pleural mesothelioma
- Dr. Eugene Choi – Surgical oncologist in Houston, TX, specializing in peritoneal mesothelioma
- Dr. Joseph Friedberg – Thoracic surgeon in Philadelphia, PA, specializing in pleural mesothelioma
- Dr. James Pingpank – Surgical oncologist in Pittsburgh, PA, specializing in peritoneal mesothelioma
Below are some of the top mesothelioma cancer centers for mesothelioma surgery.
- Brigham and Women’s Hospital – Boston, MA; Specialty: Pleural Mesothelioma
- Baylor St. Luke’s Medical Center – Houston, TX; Specialty: Peritoneal Mesothelioma
- Wake Forest Baptist Health – Winston-Salem, NC; Specialty: Pleural Mesothelioma and Peritoneal Mesothelioma
- University of Pittsburgh Medical Center – Pittsburgh, PA; Specialty: Peritoneal Mesothelioma
Our patient advocate team can help you contact one of these top mesothelioma doctors for surgery. Find an experienced mesothelioma surgeon using our free Doctor Match program.
Preparing for Mesothelioma Surgery
Ways to prepare for mesothelioma surgery include living a healthy lifestyle, researching each surgery option, learning about the recovery process, and discussing options with a doctor. This preparation can help patients immensely.
Here are four tips to help prepare for mesothelioma surgery:
- Do your research. Learn what each mesothelioma surgery entails, including which linings and organs might be removed. For example, if you’re considering extrapleural pneumonectomy surgery, then it is important to know one of your lungs will be removed. If you’re considering cytoreduction with HIPEC, then you may need to have your spleen removed.
- Ask your doctor questions. Do not hold back on the questions you ask your doctor. Ask about their experience performing the surgery, the chances of successfully removing all of the tumors from your body, and what they plan to remove. For example, some doctors who perform the pleurectomy/decortication surgery also remove part or all of the diaphragm. Some doctors who perform cytoreduction with HIPEC will remove the peritoneum before the heated chemotherapy part.
- Live a healthy lifestyle. Improving your nutritional status and strengthening your body for the upcoming procedure and setting yourself up for a good recovery is important. Eating healthy foods, adding nutritional supplements and mild exercise (like walking) can improve your immune system and help you heal.
- Talk regularly with your Mesothelioma Guide patient advocate. Registered nurse Karen Ritter can guide you through preparing for your surgery and provide additional tips and insight into what you should be doing in the months, weeks and days leading up to your procedure. Email Karen at karen@mesotheliomaguide.com for the quickest way to get her expert advice.
Diet tips: The National Cancer Institute recommends eating a high-calorie, high-protein diet before a major surgery for mesothelioma. Patients or their caregivers should plan easy-to-make meals prior to surgery and store them in the pantry or freezer to conserve energy during outpatient recovery.
Frequently Asked Questions About Surgery for Mesothelioma
Is surgery available for people with mesothelioma?
There are three aggressive mesothelioma surgery options. Two are used for people with pleural mesothelioma: pleurectomy/decortication (P/D) surgery and extrapleural pneumonectomy (EPP) surgery. One is for people with peritoneal mesothelioma: cytoreduction with HIPEC surgery.
What happens during mesothelioma surgery?
Doctors and other medical professionals remove mesothelioma tumors from the patient’s body during surgery. The goal is to remove as many tumors as possible. Accomplishing this goal may involve removing an organ – such as one of the lungs. Doctors usually remove tissue linings where they know tumors are present and spreading.
What happens after mesothelioma surgery?
Patients may experience side effects from mesothelioma surgery. The common side effects include difficulty breathing, infection, blood clots, bowel obstructions, and pain. These side effects are manageable. Patients often go through rehabilitation during the surgery recovery process, which can take several weeks or months before the patient is 100% recovered.
How long do people live after mesothelioma surgery?
Survival rates following mesothelioma surgery vary depending on the study, the patients in the study, the hospital running the study, and doctors performing the procedures. Surgery for mesothelioma usually leads to survival of at least two years following the procedure. Some patients enjoy living cancer-free for 4-5 years or more.
How can people with mesothelioma receive surgery?
The best way to receive surgery for mesothelioma is to contact a patient advocate at Mesothelioma Guide. These experts will match you with an experienced doctor and help connect you to the medical team at the top mesothelioma cancer centers. Once you meet with your doctor and learn if you’re a good candidate for surgery, you’ll schedule a surgery date and begin preparing your body for the operation.
How should I prepare for mesothelioma surgery?
People about to receive surgery to remove mesothelioma cancer should try to make their body stronger before the procedure. Tips to accomplish this include improving nutritional status and adding mild exercises, like walking. Other ways to prepare for surgery include researching what each surgery entails and preparing meals for after the procedure to conserve energy during recovery.
Sources & Author
- Extra-Pleural Pneumonectomy (EPP) in Children and Adults with Locally Advanced Sarcoma: A CanSaRCC Study. Current Oncology. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9221731/. Accessed: 06/02/2024.
- Extrapleural pneumonectomy (EPP) vs. pleurectomy decortication (P/D). Annals of Translational Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497106/. Accessed: 02/16/2021.
- Surgical Oncology. Tufts Medicine. Retrieved from: https://www.tuftsmedicine.org/services-treatments/surgical-oncology. Accessed: 06/06/2024.
- Pericardiectomy. Cleveland Clinic. Retrieved from: https://my.clevelandclinic.org/health/treatments/17352-pericardiectomy. Accessed: 02/16/2021.
- Extrapleural Pneumonectomy. University of California San Francisco Department of Surgery. Retrieved from: https://surgery.ucsf.edu/procedure/extrapleural-pneumonectomy. Accessed: 12/12/2023.
- Peritoneal Surface Malignancy Program. Johns Hopkins Medicine. Retrieved from: https://www.hopkinsmedicine.org/surgery/specialty-areas/surgical-oncology/peritoneal-surface-malignancy-program.html. Accessed: 03/31/2021.
- HIPEC Surgery – What to Expect. Tufts Medical Center. Retrieved from: https://www.tuftsmedicalcenter.org/patient-care-services/Departments-and-Services/Cancer-Center/Clinical-Care-Services/Peritoneal-Surface-Malignancy-Program/What-to-Expect-After-HIPEC-Surgery. Accessed: 03/31/2021.
- Pleurodesis. St. Vincent’s Hospital Lung Health. Retrieved from: https://www.svhlunghealth.com.au/procedures/procedures-treatments/pleurodesis. Accessed: 04/26/2021.
- Thoracentesis. National Heart, Lung, and Blood Institute. Retrieved from: https://www.nhlbi.nih.gov/health-topics/thoracentesis. Accessed: 04/26/2021.
- Learning About Paracentesis. MyHealth.Alberta. Retrieved from: https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abo2968. Accessed: 04/26/2021.
- Pericardiocentesis (Pericardial Tap). Healthline. Retrieved from: https://www.healthline.com/health/pericardiocentesis. Accessed: 04/26/2021.
- Tests for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/types/malignant-mesothelioma/detection-diagnosis-staging/how-diagnosed.html. Accessed: 06/06/2024.
- Prolonged survival and novel prognostic factors in women with pleural mesothelioma treated with extended pleurectomy decortication. Translational Lung Cancer Research. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/38736489/. Accessed: 06/06/2024.
- Impact of Surgery on Disease Progression and Survival of Patients with Pleural Mesothelioma. Annals of Thoracic Surgery. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/38428631/. Accessed: 03/13/2024.
- Extrapleural pneumonectomy (EPP) vs. pleurectomy decortication (P/D). Annals of Translational Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497106/. Accessed: 06/06/2024.
- Long-Term Survival in Patients Treated with Cytoreduction and Heated Intraperitoneal Chemotherapy for Peritoneal Mesothelioma at a Single High-Volume Center. Annals of Surgical Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/36754945/. Accessed: 06/22/2023.
- After Mesothelioma Surgery. Cancer Research UK. Retrieved from: https://www.cancerresearchuk.org/about-cancer/mesothelioma/treatment/surgery/after-surgery. Accessed: 06/05/2024.
