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Which surgery for mesothelioma

Men and women discussing mesothelioma

This page is about possible operations for mesothelioma. There is information about

 

A quick guide to what's on this page

Which surgery for mesothelioma?

Surgery is not suitable for everyone. It cannot usually get rid of the mesothelioma for good. The aim is to try and keep the disease under control and help you to stay well for as long as possible.

Surgery for pleural mesothelioma

You may be offered an operation called a pleurectomy (decortication) to help control symptoms. The surgeon will take away as much of the mesothelioma as possible. This means removing the outside covering of the lung (the pleura) on one side of the chest. It can help to control fluid build up in the chest and relieve some chest pain. This is a major operation, but it can be done using keyhole surgery.

Some people may have an extrapleural pneumonectomy. This means removing the lung on the affected side. The covering surrounding the lung (pleura), diaphragm and covering of the heart (pericardium) are also removed. This operation is not commonly used in the UK.

Surgery for peritoneal mesothelioma

Surgery is not often possible for people with peritoneal mesothelioma. If surgery is possible, the operation is called a peritonectomy. This means removing the peritoneum (the lining of the abdomen). Recently, a technique called cytoreductive surgery has been developed. This involves having a number of surgical procedures, with chemotherapy given directly into the abdomen at the same time.

 

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Why you might have surgery for mesothelioma

Surgery is not suitable for everyone with mesothelioma. It cannot usually get rid of the mesothelioma for good. The aim is to try and keep the disease under control and help you to stay well for as long as possible.

There is detailed information about what happens before surgery and after surgery for mesothelioma in this section.

 

Surgery for pleural mesothelioma

Surgery for mesothelioma in the chest (pleural mesothelioma) usually just removes the part of the pleura containing the mesothelioma (called a pleurectomy). A pleurectomy can help to control symptoms and give you a better quality of life.

Diagram showing the two layers of the pleura

Very rarely, in people with early stage mesothelioma the surgeon may take away the pleura, the lung, pericardium (heart lining) and diaphragm on the affected side (called extrapleural pneumonectomy). If you are having an extrapleural pneumonectomy, it is usually as part of an overall treatment plan that includes radiotherapy and chemotherapy to try to control the mesothelioma for as long as possible.

Pleurectomy

Pleurectomy means removing the pleura from around the lung. The lung is left behind. This type of surgery is also called decortication. The pleural space around the lung is treated so that no further fluid can collect there. You may be offered a pleurectomy to help control symptoms. It can help to control fluid build up in the chest and relieve chest pain for many people. This is a major operation that can be done using keyhole surgery. If you have keyhole surgery you will have 3 wounds, each about an inch long (2cm).

The surgeon will take away as much of the mesothelioma as possible. This means removing the outside covering of the lung (the pleura) on one side of the chest. You will have to stay in hospital for about 7 days afterwards. It will take you about 4 to 6 weeks to fully recover.

Alternatively, the surgeon may offer to remove all the pleural tumour (total pleurectomy). This is a major operation that can only be done through a large opening in your chest (thoracotomy). You will have to stay in hospital for 10-15 days afterwards and it will generally take about 6 weeks to fully recover. This kind of operation is only performed at a few centres of expertise in the UK and sometimes as part of a surgical trial. 

Extrapleural pneumonectomy (EPP)

Extraplural pneumonectomy (EPP) is a major operation. It means removing the lung on the affected side. The surgeon also removes the pleura, the diaphragm and the covering of the heart (pericardium).

EPP is only suitable for a few people with pleural mesothelioma. Your mesothelioma must be at an early stage. This means that it must not have spread into the lymph nodes, or be growing into any other areas outside the lung.

This major surgery is not often used in the UK. Research comparing EPP with no surgery found that it caused a lot of side effects and took many months to recover. The operation is very difficult and between 5 to 10% of people die during or just after the surgery. It is usually used together with chemotherapy or radiotherapy. The combination of treatments causes a lot of side effects and is very difficult to cope with. So your doctor will discuss with you very carefully beforehand whether you feel that the benefit of the operation outweighs the risk in your case.

To do the operation, your surgeon will usually make a cut into the side of your chest (a thoracotomy). You will have a wound about 9 inches long. You will need to stay in hospital for at least 2 weeks afterwards. It will take you at least 6 to 8 weeks, and possibly 3 to 4 months, to fully recover.

 

Surgery for peritoneal mesothelioma

Surgery is not often possible for people with mesothelioma in the abdomen (peritoneal mesothelioma). But if surgery is possible, the operation is called a peritonectomy. This means removing the peritoneum (the lining of the abdomen). In recent years some doctors have developed a technique known as cytoreductive surgery.

Cytoreductive surgery involves the surgeon carrying out total peritonectomy, to remove as much of the cancer as possible. During the operation, chemotherapy is given straight into the peritoneal cavity. Research has suggested that the chemotherapy works better if it is heated to a few degrees above body temperature first. This is called hyperthermic intraoperative intraperitoneal chemotherapy (HIIC). Chemotherapy into the abdominal cavity may be repeated a few times after the surgery.

Cytoreductive surgery has worked well for some people. In some studies, about half of the patients treated in this way were still alive 5 years later. But this is very intensive treatment and is only possible for people who are very fit and have earlier stage mesothelioma.

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Updated: 24 November 2015