Mesothelioma Surgery

Mesothelioma surgery may be an option for patients to remove tumors and alleviate symptoms.

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Key Points

1
Surgery is often combined with chemotherapy and radiation.
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There are three types of surgery, including diagnostic, potentially curative, and palliative.
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Potentially curative surgeries are often reserved for patients in good overall health.
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Palliative surgery can relieve symptoms and ensure a patient’s quality of life.

Mesothelioma patients have several surgical options available to them, including procedures to determine staging, remove tumors or improve quality of life. When combined with chemotherapy and radiation, mesothelioma surgery can help improve patient outcomes for those with early stages of the cancer. For patients with more advanced mesothelioma, the cancer will likely have spread distantly, so surgery for cure is no longer a viable option.

What Types of Mesothelioma Surgery Are Available

There are three main types of surgical treatments available for patients, including diagnostic, potentially curative, and palliative care. Diagnostic surgery, which includes different types of biopsies, may be needed to diagnose malignant mesothelioma. Once the cancer is confirmed, a mesothelioma specialist will develop a patient’s treatment plan. Depending on the type and stage of mesothelioma, other surgical options might be recommended.

Diagnostic Surgery

Once other diagnostic tests, including X-rays and CT scans, have been completed, a biopsy will be performed to examine a tissue or fluid sample and confirm the mesothelioma diagnosis. When attempting to diagnose pleural mesothelioma or pericardial mesothelioma, a thoracic surgeon will examine the heart and lungs for cancer.

Pleural and Pericardial Mesothelioma Diagnostic Surgeries

Thoracotomy

This involves making a large incision between the ribs in the chest to remove large tumor samples and fluid buildup.

Thoracoscopy

During a thoracoscopy, a thoracic surgeon will make one or more small incisions between the ribs, then use a video camera to examine a patient’s chest wall and the lungs. The doctor may also take samples of tissue for further analysis.

Mediastinoscopy

An incision is made in the neck above the sternum (breastbone) to insert a camera. The camera is used to investigate the area between the lungs known as the mediastinum.

Because peritoneal mesothelioma develops within the abdomen, there are several unique procedures mesothelioma surgeons may perform to take tumor samples and diagnose the disease.

Peritoneal Mesothelioma Diagnostic Surgeries

Laparoscopy

A laparoscope is a camera used to see inside the abdomen and check for tumors in the lining of the peritoneal tissue. Biopsies can also be taken during the process.

Laparotomy

This procedure involves a larger incision than a laparoscopy, and is typically used when doctors need a large tumor sample to biopsy. Sometimes a surgeon may attempt to remove the entire tumor during this process.

Potentially Curative

Typically reserved for patients who are in good health, curative surgeries aim to remove as much of the cancer as possible. Those who undergo these surgeries combined with chemotherapy and radiation as part of multimodal treatment often see higher survival rates. For example, cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) offers peritoneal mesothelioma patients a 5-year survival rate of more than 50%. Curative surgeries include:

Potentially Curative Mesothelioma Surgeries

Extrapleural Pneumonectomy (EPP)

An EPP is a surgery for pleural mesothelioma patients in which an entire lung and lining of lung, and sometimes part of the diaphragm and pericardium (sac surrounding the heart) are removed. The procedure is typically reserved for patients with early stage cancer who are in good health.

Pleurectomy/Decortication (P/D)

P/D is a surgery for pleural mesothelioma patients in which the lining of the lung, and sometimes part of the diaphragm are removed. The lung itself is left in place during this operation.

Cytoreduction and HIPEC

For patients with peritoneal mesothelioma, cytoreduction and HIPEC may be an option to address tumor growth. The two-step surgery begins with removing as much of the cancer as possible, then circulating a heated chemotherapy wash throughout the abdominal cavity to remove remaining cancer cells.

Pericardiectomy

A surgery for pericardial mesothelioma, this process involves removing some or all of the membrane surrounding the heart. This is meant to get rid of the tumors and relieve pressure, improving heart function.

Palliative

Palliative surgeries are sometimes performed alongside potentially curative ones, but are generally meant to relieve symptoms and can improve a patient’s general quality of life in the disease’s late stages.

A few examples of palliative care surgeries include procedures that remove fluid from around the organs, such as:

Pericardiocentesis: Used to treat pericardial effusion
Pleurodesis: Used to treat pleural effusion
Paracentesis: Used to treat abdominal ascites
Thoracentesis: Used to treat pleural effusion

These palliative care options can also be performed during the diagnostic process to collect fluid samples and help doctors determine whether mesothelioma is present.

Side Effects and Recovery After Mesothelioma Surgery

Mesothelioma surgery, like any other surgical procedure, carries a certain amount of risk, and complications may develop. Oftentimes, it relates to how aggressive the procedure is. Those in better overall health may experience fewer side effects, but most patients will have some degree of pain, swelling and bruising following their procedure that will eventually dissipate.

Common Complications of Mesothelioma Surgery

Bleeding
Fatigue
Heart complications
Low blood pressure
Loss of appetite
Numbness

In rarer cases, patients may suffer from hemorrhages, blood clots, respiratory failure or heart attacks. In addition to watching for these side effects, when caring for a surgical wound, patients should look for signs of infection or other problems affecting the area. Symptoms can include increased redness, additional swelling or bleeding, pus, or a sustained fever.

Patients should discuss any side effects they are experiencing with their medical team, who may be able to recommend lifestyle and dietary changes or additional medication to combat symptoms. Mesothelioma patients and their loved ones may also find help through online or in-person support groups.