Mesothelioma Surgery

What Are the Surgical Options for Mesothelioma?

Surgical options for mesothelioma include extrapleural pneumonectomy, pleurectomy/decortication and peritonectomy. These tumor-removing surgeries cut out as much cancer as possible.

Palliative surgeries treat fluid buildup around the lungs or abdomen. The goal of any surgery is to help you feel better and live longer. 

Diagnostic surgical procedures play a pivotal role in confirming the type and stage of mesothelioma. Thoracoscopy, also called video-assisted thoracoscopic surgery, is the most accurate diagnostic test for pleural mesothelioma. A laparoscopy is the best for diagnosing peritoneal mesothelioma.

You might undergo multiple surgeries to diagnose and treat mesothelioma. Which procedures your doctor recommends will vary depending on the type and stage of mesothelioma you have. 

Pleural Mesothelioma Surgery Options

Pleural mesothelioma has the most surgical options. However, these procedures are less effective than surgeries for peritoneal mesothelioma patients. 

About 15% to 20% of patients with pleural mesothelioma qualify for surgery. Specialists will recommend the treatment for mesothelioma that best meets your needs and goals.

Multimodal therapy combines major, tumor-removing surgery with other treatments, including radiotherapy and chemotherapy. This aggressive treatment approach can extend life expectancy.  

Curative Surgeries for Pleural Mesothelioma

The most aggressive surgeries for pleural mesothelioma include pleurectomy and decortication and extrapleural pneumonectomy. Surgeons use more aggressive surgeries on people diagnosed in the early stages of mesothelioma. When deciding between pleurectomy versus pneumonectomy, surgeons will consider your unique medical needs and preferences.

These surgeries may take several hours to complete, and recovery time varies depending on the procedure. A 2024 long-term survival analysis published in the journal Clinical Lung Cancer found the pleurectomy and decortication patient group had 10-year overall survival rates of 16%, significantly higher than any other group.

Palliative Surgeries for Pleural Mesothelioma Patients

Palliative procedures help control symptoms and improve quality of life. They may be an option for people at all stages of pleural mesothelioma, on their own or in conjunction with curative treatment.

Patients not eligible for more aggressive mesothelioma treatment options may elect these palliative surgeries, and some people live longer thanks to these surgeries. Risks include pain at the incision site and infection. 

Michael Cole

Verified Asbestos.com Survivor

Don’t Be Afraid of Aggressive Mesothelioma Treatment

When I was diagnosed with malignant pleural mesothelioma my specialist told me extrapleural pneumonectomy surgery with heated intrathoracic chemotherapy, or HITHOC, was the best course of action for my case. I said, ” I want you to get everything you can see, everywhere you think it might be hiding and everywhere you think it might go.” He was visibly relieved when I told him that.

Michael Cole

Verified Asbestos.com Survivor

Read Michael’s Story

Peritoneal Mesothelioma Surgery Options

The most effective and aggressive surgery for peritoneal mesothelioma is a peritonectomy with heated chemotherapy, known as HIPEC. Approximately 50% of peritoneal mesothelioma patients qualify for tumor-removing surgery.

Doctors use debulking and cytoreductive surgery techniques during a peritonectomy to remove as much tumor tissue as possible. Benefits include improved symptoms and longer survival when combining a peritonectomy with a cytoreductive surgical technique and HIPEC. 

Repeat HIPEC surgery patients live 67.7 months or 5.6 years, according to a 2022 study published in Annals of Surgical Oncology. Risks include infection, digestive issues, excessive bleeding and constipation.

Pericardial Mesothelioma Surgery Options

Surgeries for pericardial mesothelioma involve removing affected tissue or draining fluid buildup. These procedures have varying success rates and tend to have higher risks of serious complications.

These procedures can improve quality of life and relieve symptoms like shortness of breath, coughing and chest pressure. Risks include infection, abnormal heart rate and cardiac arrest. After you get home from surgery, you should contact your doctor if draining from the incision increases or you notice chest pain or severe symptoms.

In pericardial mesothelioma patients, symptoms are often the result of inflammation of the pericardium (pericarditis) and buildup of fluid (pericardial effusion). It’s important to treat these conditions early because they can lead to deadly complications if untreated.

Surgery for Testicular Mesothelioma

The most common treatment for testicular mesothelioma is inguinal orchiectomy, a surgery to remove one or both testicles along with the spermatic cord. The risks include bleeding, infection, swelling and pain.

A urologic oncologist, a specialist in cancers of the urinary tract and reproductive system, typically performs the surgery. The surgeon may also perform a lymphadenectomy to remove nearby affected lymph nodes. 

Survival rates are higher among testicular patients compared to pericardial patients. Most patients undergo surgery and nearly 49% of them survive 5 years after diagnosis, with 33% surviving 10 years.

The statistics about surgery are based on clinical research and apply only to people diagnosed with different types of mesothelioma. These statistics do not reflect other surgery stats for the population at large.

Who Is Eligible for Mesothelioma Surgery?

You may be eligible for surgery if you’re in good overall health and your doctor is confident you can recover from potential complications. You may not qualify if you have the sarcomatoid cell type, late-stage cancer or certain preexisting conditions. It’s important to speak with a surgical specialist to determine if you meet the criteria. 

Eligibility for surgery is thoroughly vetted during a surgical consultation, where the surgeon and the surgical team review your medical history, imaging scans and biopsy results. Surgical consultations allow you to meet with the surgeon and their team to discuss everything about the procedure, including preparation and recovery.

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.

Benefits of Mesothelioma Surgery

Benefits of surgeries for mesothelioma include longer survival and improved symptoms. Pleural surgery reduces chest pain and improves breathing and coughing. Peritoneal surgery improves abdominal pain and swelling as well as digestive symptoms such as constipation. Although mesothelioma is often considered a terminal illness, surgery offers the potential for long-term survival in select cases.

Advances in surgical techniques, such as minimally invasive surgery and robotic surgery, have improved outcomes and reduced postoperative complications. Dr. Farid Gharagozloo, for example, performed the first robotic surgery for a pleural mesothelioma patient in 2013. 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.

Risks and Possible Mesothelioma Surgery Complications

The most common complications 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.

Aggressive surgery can potentially remove mesothelioma completely. However, there’s a risk that some cancer cells left behind can grow and divide to form new tumors. Chemotherapy is used in conjunction with surgery to eliminate 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. If you have any questions about complications or feel any effects are worse than they should be, call your doctor right away. Addressing complications quickly is important throughout the recovery process.

 

Mesothelioma Surgery Recovery

Each patient has a different mesothelioma surgery recovery process depending on the surgery they had, their overall health and whether any complications arise. How long it takes you to recover and the amount of pain you feel will depend on the extent of your procedure. 

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, you’ll get a prescription for oral pain medication and more information about the recovery process.

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. 

Recovery may take longer for patients who undergo aggressive surgeries such as the EPP. When we asked Dr. Jacques Fontaine, thoracic surgeon and director of the Mesothelioma Research and Treatment Center at Moffitt Cancer Center, about the EPP surgery, he said the EPP “is a tough recuperation that can take 3 to 6 months.”

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. Patients should be careful to follow any instructions and attend all medical appointments to help their recovery.

What to Do if You’re Considering Mesothelioma Surgery

Before undergoing surgery for mesothelioma, talk to your surgeon to make sure you understand the risks and benefits of the procedure. Ask questions about how the procedure may affect your body, quality of life and lifespan to make an informed decision about mesothelioma surgery.

You should prepare for surgery based on the guidelines your surgical team provides. Planning for the recovery process involves building a good support team at home and making sure your caregivers are prepared to help. Talk to your doctors about follow-up appointments to see if your surgery was successful.

Common Questions About Surgery for Mesothelioma

Can mesothelioma be removed with surgery?

Yes, aggressive surgeries attempt to remove early-stage mesothelioma completely, but some microscopic cancer cells are often left behind. Chemotherapy and radiation may help to kill the remaining cancer cells.

How will I know if I’m eligible for mesothelioma surgery?

You can book a surgical consultation with a thoracic surgeon to learn about your eligibility. They’ll review your medical records, imaging scans and pathology report to determine if surgery is appropriate.

How successful is surgery for mesothelioma?

About 24% of early-stage mesothelioma patients live at least 5 years after surgery. An EPP and P/D have a risk of failure with mortality rates around 11% and 3.1%, respectively.

What is the prognosis for mesothelioma surgery?

For early-stage mesothelioma patients who undergo aggressive surgery, the prognosis can be more favorable compared to those with advanced-stage disease. Surgery is often part of a multimodal treatment approach, and other therapies impact the prognosis as well.

Will I need additional treatments such as chemotherapy or radiation therapy following surgery?

Doctors may recommend chemotherapy to kill any remaining cancer cells after surgery and radiation to prevent local recurrence. These treatments improve the chance of long-term survival in combination with surgery.

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