Mesothelioma Surgery: What Patients Should Know

When Surgery Is an Option for Mesothelioma

Mesothelioma surgery is considered when the cancer is diagnosed at an early or localized stage and the patient is healthy enough to withstand a major operation. The goal may be curative, aiming to remove as much tumor tissue as possible, or palliative, intended to relieve symptoms and improve quality of life. The specific approach depends on the type of mesothelioma, its location, how far it has spread, and the patient's overall health.

Major Surgical Procedures for Mesothelioma

Extrapleural Pneumonectomy (EPP)

Extrapleural pneumonectomy is an extensive operation in which the surgeon removes the entire affected lung, the pleural lining, the diaphragm, and the pericardium on that side. EPP is typically reserved for patients with earlier-stage pleural mesothelioma who are in good general health. Because of the magnitude of the surgery, it requires a carefully selected patient population and a highly specialized surgical team.

Pleurectomy/Decortication (P/D)

Pleurectomy/decortication removes the diseased pleural lining and any visible tumors while leaving the lung in place. This lung-sparing approach has become more common than EPP in many centers because it generally involves a shorter recovery period and lower surgical risk. P/D can be part of a multimodal plan that includes chemotherapy and radiation therapy before or after the operation.

Cytoreductive Surgery for Peritoneal Mesothelioma

For peritoneal mesothelioma, surgeons often perform cytoreductive surgery, also called debulking, to remove as much visible tumor as possible from the abdominal cavity. This procedure is frequently combined with hyperthermic intraperitoneal chemotherapy, or HIPEC, in which heated chemotherapy is circulated inside the abdomen during surgery to target remaining cancer cells.

Eligibility and Patient Selection

Not every mesothelioma patient is a candidate for surgery. Doctors evaluate several factors, including the stage of the disease, the histological subtype, the patient's age, lung and heart function, and any comorbidities. A thorough staging workup, often involving imaging scans and sometimes mediastinoscopy, helps determine whether the cancer can be safely removed. Multidisciplinary tumor boards review each case to weigh the potential benefits against the risks.

Risks and Potential Complications

Like any major surgery, mesothelioma operations carry significant risks. Possible complications include infection, bleeding, blood clots, pneumonia, and cardiac issues. Recovery can take weeks to months, and patients may need chest tubes, physical therapy, and close monitoring in the hospital. Palliative procedures, such as pleurodesis or indwelling catheter placement, aim to control fluid buildup in the chest or abdomen and may be offered to patients who are not candidates for more extensive cancer-directed surgery.

Recovery and What to Expect

After surgery, patients typically spend time in the intensive care unit before moving to a regular hospital room. Recovery involves pain management, breathing exercises, and gradual return to daily activities. Follow-up appointments include imaging scans to monitor for recurrence. A structured rehabilitation program can help restore strength and improve long-term outcomes, especially after lung-sparing procedures.

Surgery as Part of a Broader Treatment Plan

Mesothelioma surgery is rarely the only treatment. Most patients benefit from a combination approach that may include chemotherapy before or after surgery, radiation therapy, immunotherapy, or clinical trials. The sequence of treatments is tailored to each individual, and decisions are made in consultation with a team that includes a thoracic surgeon, medical oncologist, radiation oncologist, and pulmonologist.