Doctors use surgery to remove mesothelioma from the lining of the lung, abdomen, or heart. They’ll often combine it with other treatments, like chemotherapy and radiation therapy, to increase its effectiveness.
Patients with stage one or stage two mesothelioma are often eligible for life-extending surgery. If you’ve been diagnosed with late stage mesothelioma, doctors can improve your quality of life with palliative surgery, which relieves pain caused by symptoms of the disease.
Common Surgical Procedures for Mesothelioma
Extrapleural pneumonectomy (EPP): Many consider the EPP to be the “gold standard” of treatment for pleural mesothelioma. The surgery involves removing the affected lung and surrounding tissue. Doctors often combine the EPP with intraoperative chemotherapy to increase the survival time of the patient.
Pleurectomy/decortication (P/D): This is an alternative, lung-sparing surgery to the EPP. The P/D removes the diseased lining of the lung and any tumors on the surface of the lung. Doctors often combine the P/D with intraoperative radiation to kill remaining mesothelioma cells.
Cytoreduction with HIPEC: This surgery is for patients with peritoneal mesothelioma. A surgeon removes the affected lining of the abdomen and surrounding tumors. Then heated intraperitoneal chemotherapy (HIPEC) is applied to kill remaining mesothelioma cells.
Pericardiectomy: This surgery is for patients with pericardial mesothelioma. Surgeons remove the diseased lining of the heart and any visible tumors.
Palliative surgery: Surgical procedures designed with the goal of relieving pain are called palliative surgeries. These surgeries are typically for late stage patients who are ineligible for potentially curative surgery like the procedures listed above. Early stage patients also benefit from palliative treatment.
Your doctor determines your surgery eligibility when you’re diagnosed with mesothelioma.
If you’ve already been diagnosed, it’s important to get a second opinion to make sure you’re aware of all possible treatment options—including surgery.
Pleural Mesothelioma Surgery
The goal of pleural mesothelioma surgery is to remove tumors from the chest cavity and the lining of the lungs. Eligible pleural mesothelioma patients have two surgical options: an extrapleural pneumonectomy (EPP) or a pleurectomy with decortication (P/D).
Extrapleural Pneumonectomy (EPP)
To perform an EPP, a surgeon removes the entire lung affected by mesothelioma. He or she also removes the lining of the chest wall, parts of the diaphragm, and the lining of the heart. The surgeon replaces parts removed from the diaphragm and lining of the heart with Gore-Tex, a breathable fabric membrane.
The EPP is most effective for patients with stage 1 or stage 2 mesothelioma. At these stages, it’s possible for surgeons to remove most of the cancerous tissue. This because the tumors are limited to the lining of one lung and haven’t spread too far.
Mesothelioma cell type also determines how effective an EPP will be. Patients diagnosed with an epithelioid cell type have a better chance at an improved prognosis. A recent study showed that patients with epithelioid mesothelioma had higher 2 and 5 year survival rates than those with sarcomatoid and biphasic mesothelioma.
Eligibility and Recovery
Not all pleural mesothelioma patients qualify for an EPP. To qualify, the patient must be in good health with a strong heart and properly functioning lungs. Removal of an entire lung increases the workload on the heart and remaining lung; both organs must be able to handle the extra work during recovery. Full recovery from the procedure takes 8-10 weeks, 2 of which are generally spent in the hospital.
A 2010 study on the success of this procedure reported that the median survival rate after surgery ranged from 9.4 to 27.5 months.
When it’s combined with other forms of treatment, an EPP has an even more significant impact on survival rates. Patients who underwent a combined course of treatment with an EPP, chemotherapy and radiation therapy experienced a median survival rate of 13 to 23.9 months.
Pleurectomy with Decortication (P/D)
To perform a pleurectomy with decortication (P/D), a surgeon removes the lining of the lung affected by mesothelioma and all visible tumors in the surrounding area. Doctors call the P/D a lung saving surgery because — unlike the EPP — doctors don’t remove an entire lung during the procedure.
The first steps of the P/D and the EPP are similar: both begin with a thoracotomy, an incision that opens the chest. Instead of removing an entire lung—as they would during an EPP—your surgeon will perform a pleurectomy, the removal of the inner and outer lining of the lung affected by tumor growth. After the pleurectomy is completed, they’ll perform a decortication, scraping the surface of the lung to remove all visible tumors.
Eligibility and Recovery
To qualify for a P/D, you must be diagnosed with stage one or stage two mesothelioma. During these stages, the mesothelioma has not yet metastasized, or spread, far outside one side of the body. Its limited growth allows surgeons to remove only the parts of the lung’s lining affected by tumor growth.
The P/D is a lung–sparing surgery, and as a result, does not require as much recovery time as the EPP.
In a recent medical study, researchers demonstrated that patients who had a P/D experienced a median survival rate of 20 months. Like the EPP, the P/D produces better results when doctors combine it with other treatments. Another study showed that the P/D—combined with chemotherapy and radiation therapy—produced a median survival rate of 30 months.
Peritoneal Mesothelioma Surgery
The most common surgical procedure for peritoneal mesothelioma patients is cytoreduction and heated intraperitoneal chemotherapy (HIPEC). These procedures combined have added years to the life expectancy of many patients.
Surgeons use cytoreductive surgery to remove as much tumor growth from the lining of the abdominal cavity as possible. Depending on how far the mesothelioma has spread, the surgeon may also remove parts of the gall bladder, pancreas, and stomach.
Eligibility and Recovery
Cytoreductive surgery is complex — the procedure is extensive and lasts for 10 – 12 hours. So patients in general good health may be eligible for surgery. Doctors also take how far the cancer has spread into consideration. The farther the cancer has spread, the less likely surgery can help. For patients with limited tumor growth, cytoreductive surgery is curative and offers a better chance of removing cancer from the body. Patients with advanced-stage mesothelioma have cytoreductive surgery to relieve the pain caused by tumor growth.
Patients have to recover in–hospital for approximately 2 weeks.
Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Most peritoneal mesothelioma patients eligible for cytoreduction receive HIPEC. During this procedure, a surgeon introduces heated chemotherapy into the abdominal cavity during surgery. Combining surgery and heated drugs raises the effectiveness of each. Cytoreduction reduces the tumor mass while the heated drugs kill microscopic cancer cells left behind after the surgery.
Across several medical studies, researchers have demonstrated the effectiveness of cytoreduction with HIPEC for patients with peritoneal mesothelioma. For example, a recent study reported that the median survival rate of patients treated with cytoreduction and HIPEC was 65 months — approximately 5 times the average life expectancy of mesothelioma patients.
Pericardial Mesothelioma Surgery
Pericardial mesothelioma is the rarest form of the disease. Doctors don’t get to see many cases, so surgical options are still being refined. Nevertheless, patients still have surgical treatment options if they’ve been diagnosed with mesothelioma in this location.
To perform a pericardiectomy, a surgeon removes the lining of the heart affected by tumor growth. They replace any part of the heart’s lining that was removed with a man-made material, such as as Gore-tex.
Doctors often use the pericardiectomy for patients with pericarditis, inflammation of the heart’s lining caused by tumor growth. An inflamed pericardium constricts the heart and prevents it from functioning properly. Removing the hardened pericardial lining allows the heart to return to normal functioning.
Doctors use palliative surgery to relieve pain caused by tumor growth. Doctors use palliative surgery for patients with all stages of mesothelioma. This surgery especially targets the build up of fluid in the lining of the lungs, abdomen, or heart. Fluid buildup in the mesothelial linings can create uncomfortable pressure, breathing difficulties, and pain.
- Pleurodesis: Doctors use a pleurodesis to seal the pleural cavity, which is the space between the inner and outer lining of the lung. Sealing this cavity prevents pressure caused by pleural effusions (the build up of fluid in the lining of the lungs) and prevents them from recurring.
- Thoracentesis: A thoracentesis is the removal of excess fluid in the lining of the lung affected by tumor growth. Doctors use a needle to perform this procedure.
- Paracentesis: A paracentesis is the removal of excess fluid in the lining of the abdomen. Like the thoracentesis, doctors remove excess fluid with a needle.
- Indwelling Pleural Catheter (IPC): An IPC is a palliative treatment for patients with frequently recurring pleural effusions. A doctor makes a small incision in the chest and inserts a catheter into the lung’s lining. This allows patients to drain excess fluid in the comfort of their own home.
The Right Surgery
Surgery is the best option available for improving your prognosis, and most patients have at least one surgical option available—whether it’s curative, palliative, or both.
If you’ve been diagnosed with early–stage mesothelioma, you may be eligible for curative surgery that can extend your life expectancy. If you’ve been diagnosed with advanced–stage mesothelioma, your doctor may recommend palliative surgery that can ease pain caused by symptoms, and may be able to find new treatment options in clinical trials.