Pleural mesothelioma starts in the layers of tissue that cover the lung (pleura).
Surgery is not a common treatment for mesothelioma. You might have it to diagnose or to control symptoms. Much more rarely a few people may be able to have surgery to try to help them live longer or cure their cancer. This surgery is called radical surgery.
To have radical surgery you have to be fit and well so that you can recover without too many problems.
Researchers are looking at the role of surgery for people with pleural mesothelioma. Depending on your situation, you doctor may discuss an operation with you. They can explain the risks and benefits of surgery and what clinical trials have shown so far.
Talk to your healthcare team if you are unsure whether surgery is an option for you. You could ask for the opinion of a specialist mesothelioma surgeon. Your consultant can refer you to a mesothelioma surgeon if there isn’t one at your local hospital.
Types of surgery
Surgery can be used to try to completely remove the mesothelioma. There are 2 main types of operations for this.
One type removes the pleura, or part of the pleura. This is called a pleurectomy or partial pleurectomy.
The other type is called an extrapleural pneumonectomy. It removes the following:
- the pleura and the lung
- part of the covering of the heart (the pericardium)
- the muscle under the lungs (the diaphragm)
Removing part of the pleura
The surgeon removes the part of the lining of the lung (pleura) that contains the mesothelioma.
This is a major operation that is sometimes carried out using keyhole surgery. The surgeon makes 3 small wounds, each about an inch long. They take as much of the mesothelioma away as possible. They also put a substance into the space to stop fluid building up in the future.
Instead of keyhole surgery your surgeon might need to make a large wound in your chest.
You need to stay in hospital for about 7 days afterwards. It takes about 4 to 6 weeks to fully recover.
This operation is not carried out so much.
If you have symptoms, such as shortness of breath, your surgeon may discuss this operation. Or they might suggest a different procedure. For example, you might have a small flexible tube placed between the pleura to drain the build up of fluid.
Removing the whole pleura
The surgeon removes the whole pleura from around the lung on the affected side. They make a large wound in your chest called a thoracotomy. They remove the pleura and then replace it with a specialised medical mesh layer.
You might have a slightly bigger operation called a pleurectomy decortication. This involves the removal of:
- any visible mesothelioma
- the hardened and thickened outer layer of the surface of the lung (decortication)
- the lung covering (pleura)
Depending on where the cancer is in the covering of the lungs, some people also have the removal of:
- part or all of the lining of the heart (the pericardium)
- the sheet of muscle just under the rib cage (the diaphragm)
This operation is called an extended pleurectomy decortication. You may have this operation, in combination with chemotherapy, if you have an early stage mesothelioma.
All of these pleurectomy operations leave the lungs in place. So they are called lung sparing operations. They take place in specialist hospitals in the UK.
You stay in hospital for 10 to 15 days afterwards. It takes about 6 to 8 weeks to fully recover.
Mars 2 trial
The role of a pleurectomy decortication in pleural mesothelioma is being at looked at in a large trial called MARS 2.
In one group, people have chemotherapy alone. People in the other group have chemotherapy and surgery. The researchers want to find out if people who have surgery live longer than those who don’t. They will also look at symptoms and quality of life in each group.
The trial results are expected in 2022 or 2023.
Removing the lung and pleura
For this operation, your surgeon makes a cut about 9 inches long into the side of your chest (a thoracotomy). They remove the following:
- the lung on the affected side
- the pleura
- the muscle under the lung (diaphragm)
- the covering of the heart (pericardium)
This is called an extrapleural pneumonectomy.
You need to stay in hospital for at least 2 weeks afterwards. It can take around 3 to 4 months to fully recover.
This type of surgery is not often used. It is only suitable for early stage mesothelioma that hasn't spread into the lymph nodes or grown into any other areas outside of the lung. This is a major operation.
You usually have it together with chemotherapy or radiotherapy. The combination of treatments is very difficult to cope with. Your doctor will discuss the benefits and the risks very carefully with you beforehand.
Surgery for advanced mesothelioma
The surgery aims to remove as much tumour as possible to relieve symptoms. It is called palliative surgery or debulking. It can help to reduce breathlessness.
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.