Which 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 of CancerHelp UK.

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.

Very rarely, in people with very early mesothelioma the surgeon may take away the pleura and the lung 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

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, but 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.

Extrapleural pneumonectomy (EPP)

An extraplural pneumonectomy 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. You need to be fit enough to walk up and down two flights of stairs without becoming breathless. 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 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 up to 6 different peritonectomy procedures, 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.