Understanding Mesothelioma Surgery
There are a number of surgical procedures to treat mesothelioma patients. Patients will be eligible for different surgeries depending on their health, the location of tumors, and how far the cancer has progressed.
Doctors may have two different goals for mesothelioma surgery:
- Potentially curative surgery may be an option if you are otherwise healthy and doctors can remove mesothelioma tumor(s) completely. There is no cure for mesothelioma, but curative surgeries may help you live longer.
- Palliative surgery may be an option if your mesothelioma has already entered metastasis, an advanced stage of cancer that has spread to different parts of the body. Palliative surgery focuses on easing pain and other symptoms.
Typical surgeries for mesothelioma include extrapleural pneumonectomy (EPP), pleurectomy with decortication (P/D), and cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC). These surgeries are also often combined with other treatment options like chemotherapy, radiation therapy, and immunotherapy as part of a multimodal treatment plan.
How much a surgery will help (and how long it will take to recover from one) can vary. Talking with your mesothelioma specialist is a great way to understand how surgeries and other mesothelioma treatment may help you.
Our team has also compiled a Free Mesothelioma Guide to help walk you through what to expect from mesothelioma surgery treatments.
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Eligibility for Mesothelioma Surgery
Each patient will need to talk with their mesothelioma specialist to determine if they are eligible for surgery for mesothelioma.
Patients may be eligible for mesothelioma surgery if:
- They are in good health.
- Their cancer is made up of epithelioid mesothelioma cells (these are the easiest cell types to treat).
- Their mesothelioma has not yet metastasized.
Mesothelioma doctors will perform various tests on a patient prior to recommending surgery.
These tests may include:
- Blood chemistry tests: These tests show how well your liver and kidneys are functioning.
- Heart function tests: The two most common heart function tests doctors perform before mesothelioma surgery are echocardiograms and electrocardiograms. These tests show whether your heart is healthy enough to undergo surgery.
- Pulmonary function tests: These tests may be used if you have pleural mesothelioma to see how well your lungs are working. Your care team may use these tests to determine how well your other lung will continue working if they remove one lung. If your lungs are not working well enough, mesothelioma surgery may not be a suitable option.
Unfortunately, not everyone who has mesothelioma is able to undergo surgery. The good news is that there are still treatments available even if a major mesothelioma surgery isn’t an option.
Pleural Mesothelioma Surgery
The most common type of mesothelioma is malignant pleural mesothelioma, which affects the pleura or the lining of the lungs. Pleural mesothelioma surgeries focus on removing any visible tumors in the lung lining.
Learn about the surgeries for pleural mesothelioma below.
An extrapleural pneumonectomy (EPP) is generally only performed on patients who are in good health and whose mesothelioma is still in the early stages.
In an EPP, the surgery team remove:
- The pleura (the lining of the lung)
- The diaphragm (the dome-shaped breathing muscle)
- The lung closest to the cancer tumors
- The pericardium (the membrane surrounding the heart)
- Nearby lymph nodes
Some surgeons have delivered chemotherapy directly to the thoracic cavity after an EPP in a process known as hyperthermic intrathoracic chemotherapy (HITHOC). The heated chemotherapy kills any cancer cells left behind after mesothelioma surgery. It can be used to help prevent the cancer from coming back.
An EPP is a complex operation that unfortunately can result in some complications. According to the American Cancer Society, approximately 33% of patients who get this operation experience major complications.
Your mesothelioma specialist will be able to help you through recovery and reduce the risk of complications.
Pleurectomy With Decortication
Pleurectomy with decortication (P/D) is less intensive than an EPP because both lungs are kept intact. Patients who may not be eligible for an EPP may be good candidates for a P/D.
Similar to an EPP, a P/D can be combined with heated chemotherapy or HITHOC to treat any leftover cancer cells in the thoracic cavity.
P/D procedures involve a two-part process. First, surgeons will remove the pleura around the cancerous lung. This is known as the pleurectomy. Then decortication involves surgeons removing all visible cancerous tumors.
Surgeons often use a P/D to treat early-stage pleural mesothelioma and prevent the cancer from spreading to nearby lymph nodes and organs.
Mesothelioma P/D surgery may help patients:
- Decrease chest pain
- Improve and ease breathing
- Reduce fluid buildup in the lungs
Learn how a P/D and other mesothelioma surgeries can help you with our Free Mesothelioma Guide.
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Palliative Surgeries for Pleural Mesothelioma
Your care team may recommend any of the following palliative surgeries to ease symptoms if you have advanced-stage pleural mesothelioma.
It’s possible that your care team may recommend a catheter if you have pleural effusions (fluid buildups in the lung lining) that keep coming back. If left untreated, pleural effusions can cause trouble breathing and other painful symptoms. A PleurX catheter can be inserted to help drain excess fluid from the pleura lining of the lungs.
After the catheter is inserted, you can drain the fluid at home and reduce your visits to the hospital.
This is another treatment used to help with pleural effusions. During pleurodesis treatments, doctors first drain any fluid in the pleura.
After draining the fluid, a substance such as talc is inserted into the pleura. This will cause your lung to stick to the chest wall and prevent fluid from collecting in the pleura.
The purpose of pleurodesis is to reduce patient discomfort, hospital visits, breathing difficulties, and treatment costs.
With a thoracentesis, doctors will insert a thin needle into the pleura to drain pleural effusions.
Pleural effusions may come back, so you may need more than one thoracentesis performed. Doctors might recommend getting a catheter in persistent cases.
Peritoneal Mesothelioma Surgery
Peritoneal mesothelioma is the second-most common type of mesothelioma. It affects the peritoneum, the lining that covers most of your abdominal organs.
Surgery for peritoneal mesothelioma can focus on easing symptoms or improving life expectancy. Learn about each of the surgeries for peritoneal mesothelioma below.
Cytoreductive Surgery (Debulking)
Also known as debulking or complete peritonectomy, cytoreductive surgery involves removing the entire peritoneum, as well as parts of internal organs like the liver, spleen, and stomach, to get rid of as much cancer as possible. It’s also known as a debulking or a peritonectomy.
Providers often use cytoreductive surgery along with HIPEC. After removing the mesothelioma tumors, they bathe the abdominal cavity with heated chemotherapy drugs to kill cancer cells that remain.
Peritoneal mesothelioma often spreads to the omentum, a layer of fatty tissue that covers some of your abdominal organs, such as your intestines and stomach.
Omentectomy removes this lining and any visible tumors if possible.
If your peritoneal mesothelioma is advanced and has spread to other parts of your body, your care team may recommend palliative options to improve your quality of life.
For example, a paracentesis is a palliative surgery that relieves ascites (fluid buildup in the abdomen that causes stomach pain and bloating). During the procedure, doctors use a thin needle to drain the fluid.
Our team can help you find top mesothelioma treatments faster. Get started with a Free Mesothelioma Guide.
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Types of Surgery for Pericardial Mesothelioma
Pericardial mesothelioma affects the pericardium, the lining of the heart. While surgical treatment for this type of mesothelioma is incredibly rare, there are some options for patients.
Surgeries for pericardial mesothelioma include:
- Tumor resection: Removes tumors without removing the pericardium.
- Pericardiectomy: Removes all or part of the pericardium and visible mesothelioma tumors.
Palliative surgeries, such as a pericardiocentesis, can help patients ease chest pain. It involves a health care provider using a needle and a small catheter to drain excess fluid from the pericardium.
Types of Surgery for Testicular Mesothelioma
Testicular mesothelioma forms in the tunica vaginalis, the membrane surrounding the testicles. It is one of the rarest types of mesothelioma.
The most common potentially curative surgery for testicular mesothelioma is radical inguinal orchiectomy, which involves removing one or both testicles along with the spermatic cord.
If the mesothelioma has spread to nearby lymph nodes, the care team may also perform a lymphadenectomy to remove affected lymph nodes.
Mesothelioma Survival After Surgery
Each type of mesothelioma responds differently to treatment. As a result, mesothelioma survival time after surgery will vary with each patient. However, those who undergo various surgeries often see improvements in their mesothelioma prognosis (overall health outlook).
Learn about each of the life expectancies and survival rates for each mesothelioma surgery below.
|5-Year Survival Rate
|Cytoreduction with HIPEC
It’s important to remember that survival rates and life expectancies are only estimates. Some patients may live for many years or decades depending on how their body responds to mesothelioma surgeries and other treatments.
Mesothelioma Surgery Specialists
It is incredibly important to work with mesothelioma oncologists (cancer doctors) who specialize in surgical treatments for the type of mesothelioma you have.
Learn more about some of the top mesothelioma surgeons in the U.S. below.
Dr. Robert Cameron
Dr. Robert Cameron performs pleural mesothelioma surgery at the UCLA Medical Center in Los Angeles, California, where he serves as the director of the Comprehensive Mesothelioma Program.
Dr. Cameron has treated patients for over 20 years and has been credited with inventing the P/D surgery for mesothelioma.
Dr. Raja Flores
Dr. Raja Flores is the Chairman of the Department of Thoracic Surgery and an Ann Ames Professor in Thoracic Surgery at New York’s Mount Sinai Medical Center.
He is a recognized leader in thoracic surgery and a pioneer in mesothelioma surgery.
Dr. Taylor Ripley
Mentored by the renowned mesothelioma specialist Dr. David Sugarbaker, Dr. Taylor Ripley is the Director of the Mesothelioma Treatment Center and an associate professor at Baylor College of Medicine’s Lung Institute.
Dr. Ripley specializes in robotic surgery to provide minimally invasive approaches to mesothelioma.
Dr. Richard Alexander
Dr. Richard Alexander is Chief Surgical Officer at New Jersey’s Rutgers Cancer Institute. A renowned oncologist, he researches mesothelioma tumors at the molecular level.
He is known for using cytoreductive surgery with HIPEC to treat his patients.
Dr. Hedy Lee Kindler
Dr. Hedy Lee Kindler treats both pleural and peritoneal mesothelioma. She leads the University of Chicago’s mesothelioma treatment program and gastrointestinal oncology division.
She is also an associate editor of the Lung Cancer medical journal and has published numerous review articles, journal articles, abstracts, and book chapters.
Dr. James Pingpank
Dr. James Pingpank is a surgical oncologist at the University of Pittsburgh Medical Center and an associate professor of surgery at the University of Pittsburgh’s School of Medicine.
As an expert in gastrointestinal cancers, Dr. Pingpank focuses on cytoreduction with HIPEC for peritoneal mesothelioma.
Find top doctors who can perform mesothelioma surgeries with our team’s help. Start the process by calling (888) 360-2406.
Mesothelioma Surgery Recovery
The recovery process will vary depending on your health, the type of mesothelioma surgery, and if you have complications.
Some patients may be asked to stay in the hospital for up to 2 weeks. However, outpatient, when patients recover from surgery at home, recovery times may vary.
Outpatient recovery times for each type of mesothelioma surgery are as follows:
- EPP: 6-8 weeks
- Cytoreduction with HIPEC: Up to 3 months
- P/D: 4-8 weeks
As you recover, it is important to be mindful of symptoms, side effects, and other complications so you can alert your doctor immediately. If infections or other complications are not treated as soon as possible, even more serious conditions can arise.
Some side effects and complications from mesothelioma surgeries include:
- Bleeding: After pleural mesothelioma surgery, some patients may cough up a bit of blood. This should disappear after a few days. You may also experience a small amount of bleeding from your incisions. Contact your care team if you experience severe bleeding.
- Cardiac complications: Irregular heartbeats, blood clots, and more may develop after major surgeries. Your provider may provide medication to keep your heartbeat steady.
- Fatigue: After the anesthesia wears off, you may continue feeling fatigued, especially after a major operation like EPP or P/D.
- Fluid buildup: Fluid may build up in the lungs or the abdomen. Doctors will need to perform follow-up procedures to drain the excess fluid.
- Infections: Because your immune system is weakened from mesothelioma and the procedure, your body may have a harder time combating infection. If you feel feverish and run 100.4 F for over an hour, tell your care team.
- Pain and swelling around the incision(s): This is the most common side effect as your body works to heal tissues. Sometimes the pain from incisions can radiate throughout the body. If these symptoms worsen, talk with your doctor.
- Pneumonia: A common complication after major chest surgery, pneumonia causes pus or fluid buildup in the lungs.
Find Resources for Mesothelioma Surgery Today
Receiving a mesothelioma diagnosis is often traumatizing and stressful. The idea of surgery and the resulting recovery time can also bring on anxiety.
You don’t have to navigate this time alone. If you or a loved one has been diagnosed with mesothelioma, reach out to Mesothelioma Resource Group today. We can help match you with specialists, treatment options, and financial aid.
Download a Free Mesothelioma Guide today to get connected to the resources you need.
Mesothelioma Surgery FAQs
Can mesothelioma be removed with surgery?
Possibly, yes. Whether your mesothelioma can be removed with surgery depends on the type and stage of mesothelioma. In more advanced stages it can be difficult to fully remove with surgery.
Can you remove a lung with mesothelioma?
Possibly, yes. An EPP is a mesothelioma surgery to remove a lung impacted by mesothelioma tumors. Not all patients will need to have a lung removed, though.
An alternative surgery — the P/D — allows doctors to remove cancer from the lung lining without having to take out a lung. Patients treated with a P/D live almost as long as those treated with an EPP, and there’s a lower chance of long-term complications
It is important to talk with your specialist to see which pleural mesothelioma surgeries you are eligible for.
How long does mesothelioma surgery take?
The length of a mesothelioma surgery depends on the type. Most aggressive surgeries for mesothelioma, such as an EPP and a P/D, require several hours, and some patients may be required to stay in the hospital for 2 weeks post-operation.
Once home from the hospital recovery from mesothelioma surgery can take 6-8 weeks for an EPP and 4-8 weeks for a P/D.
What are the chances of surviving mesothelioma with surgery?
The chances of becoming a long-term survivor depends on how your body responds to mesothelioma surgeries and other treatments.
Though rare, may be possible to live for decades thanks to major surgeries and medical care.
For example, Julie Gundlach is still alive over 15 years following a peritoneal mesothelioma diagnosis after undergoing multiple surgeries.