Treating Mesothelioma with Surgery

Whether you are a candidate for surgery and what type of surgery you will have depends upon your general health, your heart and lung function, the stage of the illness, and the extent and the location of the cancer. If you are enrolled in a clinical trial, this might also influence what type of surgery you have.

There is controversy about which form of surgery is best. Some surgeons believe radical surgery has the best chance of removing all the cancer while others are concerned about the long-term health effects of such aggressive treatment.

It is essential that you and your loved ones understand your options. Ask your medical team about the benefits and consequences of all procedures. Keep a notebook in which you can write questions to ask every doctor you see and to keep notes about all the options discussed. Take your notebook to every visit.

The most common potentially curative operations for pleural mesothelioma (which attacks the lining of the lungs and chest) are:

Pleurectomy/Decortation

In this operation, the surgeon treats the disease by performing a pleurectomy - removing all of the visible tumor in order to free the lung. It is usually attempted in patients whose disease is at Stage I or Stage II.

Pleurodesis

Often, after the pleural effusion (fluid buildup in the chest) has been drained during thoracentesis, the fluid comes back. In this case, talc or other materials are placed in the chest to close the pleural space and prevent the buildup. This can be done in combination with chest tube drainage or with thoracoscopy and video-assisted thoracic surgery (VATS).

There are concerns that pleurodesis may get in the way of certain treatments later on and make surgery more difficult, so it is always important to discuss and weigh all benefits and consequences of every procedure with your medical team.

Pleurectomy

This procedure involves stripping off the visceral pleura (the lining on the surface of the lung) and the parietal pleura (tissue that covers the lung and lines the inside of the chest cavity). This is usually performed when more extensive surgery to remove all of the cancer is not an option. It aims to relieve chest pain and prevent recurrent pleural effusion (abnormal fluid buildup between the lining of the lung and the wall of the chest).

Extrapleural Pneumonectomy (EPP)

An EPP involves removal of a lung and part of the parietal pleura (the membrane lining the chest) on the affected side. Often, the surgeon also removes part of the pericardium (the membrane surrounding the heart) and part of the diaphragm (the muscle between the abdomen and the lungs). It is particularly important to find a very experienced specialist for this extremely complicated operation.

Pneumonectomy

Removal of a lung.

The most common operation for peritoneal mesothelioma (which attacks the tissue surrounding the abdominal area) is:

Cytoreductive Surgery

This operation aims to remove all or nearly all of the visible tumor in the peritoneal cavity (the abdominal space containing the intestines, stomach, and liver). It is followed by a special heated chemotherapy treatment called intra-peritoneal hyperthermic chemotherapy (IPHC).