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Mesothelioma Surgery: Is It an Effective Treatment?

When you’re exposed to asbestos, tiny fibers can enter your body and cause cells to mutate and develop into mesothelioma. The length of time between the exposure and the development of this type of cancer is longer than you might expect: typically 20 to 60 years or more. Over time, the cancer cells form in the lining of the lungs, heart, testicles, or abdominal cavity before spreading throughout the body. 

Surgery is one of the treatment options for mesothelioma. It is especially effective when paired with other treatments like chemotherapy, immunotherapy or radiation therapy. For those with early-stage cases, mesothelioma surgery can be effective for removing the cancer from the body and improving quality of life

A mesothelioma surgeon or oncologist may create a customized treatment plan based on your overall health, age, type of mesothelioma, and other factors. You can find mesothelioma specialists and advanced healthcare options at cancer centers nationwide. If you would like more information, please reach out to our Mesothelioma Advocate Team.

Types of Surgery Used to Treat Mesothelioma

Mesothelioma surgery generally falls into one of three categories: diagnostic, potentially curative, and palliative. The goals for each differ, and each has a different set of requirements for the patient. Mesothelioma specialists will vary their recommendations based on your overall health, other treatments that are being used, and the type and stage of your unique case.

Diagnostic Surgery Options

Diagnostic procedures can help your doctor gather more information about your cancer. That way, your care team can better understand how the disease has affected your body and make a clearer diagnosis. A doctor may take a small portion of tissue – called a biopsy – for laboratory examination. If it is a minimally invasive surgery, you have a low risk of complications and can often go home the same day or remain in the hospital for just a short period. 

Potentially Curative Surgery Options

Potentially curative surgery aims to remove as many mesothelioma cancer cells as possible. It requires an open procedure and has a longer recovery period. Potentially curative surgery is mainly provided to patients with an early-stage diagnosis. It is most effective when the cancer is in one part of the body before it has spread to other areas. Potentially curative surgery offers the best chance of long-term survival.

Palliative Surgery Options

The goal of palliative surgery is not to cure cancer. It’s mainly used to ease symptoms for late-stage mesothelioma patients. Palliative options include procedures to remove excess fluid from the body and surgery to remove as much of the mesothelioma as possible. Palliative procedures can be used in combination with a variety of different treatments, including chemotherapy drugs and radiation therapy.

Is Surgery Effective Against All Types of Mesothelioma?

There are four main types of mesothelioma:

  1. Malignant pleural mesothelioma
  2. Peritoneal mesothelioma
  3. Pericardial mesothelioma
  4. Testicular mesothelioma

Treatment options, including surgical options, are different for each patient based on the location of the mesothelioma in the body and the patient’s overall health. Oncologists will work with you and your family to identify the most promising treatment plan based on your specific case, overall health, and treatment goals.

Malignant Pleural Mesothelioma

Malignant pleural mesothelioma is the most common type of mesothelioma. Malignant pleural mesothelioma is found in the lining of the lungs (pleura), but it is different from lung cancer

Surgical treatment options are most effective for early-stage pleural mesothelioma. It is often paired with other types of treatment as part of a multimodal care plan. Surgery is generally not an option for Stage 3 or 4 pleural mesothelioma.

Pleural mesothelioma can be treated with a variety of surgeries including:

  • Extrapleural pneumonectomy (EPP): Extrapleural pneumonectomy is an aggressive type of surgery. In this extensive procedure, the surgeon removes an entire lung, the lining around it, nearby lymph nodes, and even parts of the diaphragm and heart if necessary. Surgeons may refer to this type of surgery as a resection. EPP comes with a lot of side effects, including reducing a patient’s stamina and strength permanently. However, it also offers the best chance to remove all cancer cells. EPP is not a common procedure.
  • Pleurectomy/decortication (P/D): Pleurectomy-decortication was created as a less invasive, lung-sparing alternative to the EPP. In this procedure, surgeons remove only the lining of the lung and all visible tumors instead of removing an entire lung. Because this surgical procedure is less invasive, P/D has become a more common treatment option than EPP for treating malignant pleural mesothelioma.
  • Pleurodesis: Pleurodesis is a procedure that prevents the buildup of fluid between the layers of the pleura. This fluid buildup is called pleural effusion. The procedure can reduce the fluid to make it easier to breathe and it can reduce pain. It can be repeated to reduce symptoms throughout treatment for pleural mesothelioma.
  • PleurX catheter placement: A soft flexible tube can be placed in the lungs so that patients can drain the buildup of fluid at home. The tube is called a catheter. Draining fluid buildup can help reduce chest pain and improve a patient’s breathing.
  • Pneumonectomy: A pneumonectomy allows surgeons to remove just one lung but not the lining, lymph nodes, diaphragm, or other structures. It is less invasive than the EPP. The procedure will only be effective if cancer has not spread (metastasized) beyond one lung. 
  • Thoracotomy: Thoracic surgery is generally performed in addition to a P/D, EPP, or pneumonectomy. During this surgical procedure, thoracic surgeons make an incision on either side of a patient’s chest to determine the spread of the tumor. 

Oncologists may also recommend a partial pleurectomy in which the surgeon removes just the pleura lining the lungs. This resection surgery is performed in patients with advanced mesothelioma without intent to cure patients with advanced cases.

Peritoneal Mesothelioma

Peritoneal mesothelioma is the second most common type of mesothelioma, accounting for about 20% of cases. It occurs in the lining of the abdomen (peritoneum). 

A few different surgical options are available for peritoneal mesothelioma:

  • Cytoreductive or HIPEC surgery: In cytoreductive surgery, the surgeon removes as many cancer cells as possible, including removing pieces of the intestines if necessary. It is sometimes called debulking surgery. Before the procedure is finished, surgeons often put chemotherapy drugs in the intestine. This treatment is called hyperthermic intraperitoneal chemotherapy. If the chemotherapy drugs are heated, it is called heated intraoperative chemotherapy, or HIPEC. Cytoreduction reduction with HIPEC is the standard of care for many peritoneal mesothelioma patients.  While it has complications and risks, it has often proven to be effective in providing both quantity and quality of life.
  • Omentectomy: During this procedure, surgeons remove a layer of fatty tissue inside of the abdomen called the omentum. When peritoneal mesothelioma spreads to this tissue, surgeons will remove it as part of the treatment. 

Because peritoneal mesothelioma is not the most common type of this cancer, you may find there are fewer surgical options available. However, there may be clinical trials and other treatment options in development for you to consider. 

Pericardial Mesothelioma

Pericardial mesothelioma is a rare type of mesothelioma that occurs in less than 1% of mesothelioma patients. It affects the lining of the heart (pericardium). Because doctors see so few cases, surgical options are still being refined. Nevertheless, patients still have one main surgical treatment option: pericardiectomy.

During a pericardiectomy, surgeons either remove the entire pericardium to ease pressure on the heart or they create a hole in the pericardium (called a pericardial window). This procedure also may be used to place chemotherapy drugs into the pericardium and chest wall.

Side effects of pericardial mesothelioma surgery include shortness of breath, fluid buildup in the lungs, and abnormal heart rhythms.

Testicular Mesothelioma

Like pericardial mesothelioma, testicular mesothelioma is an extremely rare type of mesothelioma. However, survival rates are higher among testicular patients compared to most other types of mesothelioma.

Testicular mesothelioma occurs in the lining of the testicles.The main surgical option is radial orchiectomy surgery. In this procedure, surgeons remove both a testicle and the spermatic cord. 

While rare, testicular mesothelioma may be the diagnosis in the event of a testicular mass.

Mesothelioma Surgical Options FAQs

What is the best surgical option for mesothelioma treatment?

Mesothelioma can affect each person differently. Specialists recommend surgical treatments on an individual basis. Doctors and cancer care teams will determine the best treatment plan for you based on your type of mesothelioma, its location, its progression, and your overall health. 

Additionally, oncologists may suggest using multiple types of treatment (multimodal treatment). Surgery may be combined with other treatment approaches, such as chemotherapy, radiation therapy, or immunotherapy. You may have the option to participate in clinical trials.

Are all surgical options available to all mesothelioma patients?

Surgical options vary depending on the type of mesothelioma you have and your overall health. Not all surgical options are available to all mesothelioma patients. Generally, patients with an early-stage diagnosis tend to have more surgical options.  For patients in poor health, specialists may recommend staying away from certain treatments that are too invasive or hard on the body.

What are the other mesothelioma treatment options?

Common mesothelioma treatment options other than surgery include:

  • Chemotherapy
  • Immunotherapy
  • Radiation therapy

Mesothelioma surgery is often most effective when combined with one or more of these other treatment options. Additionally, oncologists are constantly developing new treatments that may be available to mesothelioma patients through clinical trials

Does mesothelioma surgery impact survival rate?

Some mesothelioma surgeries can impact your survival rate. Potentially curative surgeries, for example, aim to improve survival rates by removing as many mesothelioma cancer cells from the body as possible. 

As you recover from surgery, your mesothelioma specialist will follow up to re-evaluate the prognosis. Additional treatments may be recommended. If mesothelioma is diagnosed at a later stage, surgeries may be performed as part of palliative care to ease pain and other symptoms. 

Learn More About Mesothelioma Treatment Options 

Whether palliative, potentially curative, or diagnostic, surgery can benefit mesothelioma patients at any stage of the disease. For early-stage mesothelioma, surgery can be effective for removing cancer and improving your life expectancy, especially when used with other treatments such as radiation therapy, chemotherapy, or immunotherapy. For later-stage mesothelioma, surgery may not extend survival, but it can play an important role in reducing symptoms. For all stages, surgery can be useful for improving your quality of life.

Doctors will provide you with a treatment plan based on your overall health and the location, type, and progression of your mesothelioma. Treatment options may include the opportunity to participate in clinical trials. Innovative surgical procedures that offer hope for increased survival rates may also be an option. You should work with your oncologist to develop a customized treatment plan.

To get started, download our free mesothelioma guide or call (800) 333-8975 if you need help understanding your diagnosis, finding the right oncology experts, or putting together a treatment plan.