Surgery is often the best treatment option to extend a patient’s lifespan.
During mesothelioma surgery, a specialist (usually an oncologist) works to control the growth of the cancer by physically removing all visible tumor masses and sometimes the surrounding tissues or infected organs. Patients are only eligible for surgery if they are strong enough to fully recover.
Doctors have developed surgical procedures for different types of mesothelioma. Which surgery a doctor recommends, if any, depends on what type of mesothelioma you have and how far it has spread.
Pleural Mesothelioma Surgery
The two main surgeries for malignant pleural mesothelioma are extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D). EPP is considered the more aggressive of the two, but it removes the greatest amount of mesothelioma tumors in many cases.
On the other hand, unlike the EPP, P/D allows patients to keep both lungs, but some doctors argue that it doesn’t allow for maximum tumor resection (removal).
Ultimately, the type of surgery you may get depends on the specifics of your cancer and what your doctor recommends.
Extrapleural pneumonectomy is a curative surgery usually combined with chemotherapy or radiation to help improve patient life expectancy.
This invasive procedure involves removing:
- All visible tumors
- The diseased lung
- A portion of the parietal (outer) pleura
- A portion of the diaphragm
- A portion of the pericardium (lining of the heart)
A study of 183 pleural mesothelioma patients, conducted in part by mesothelioma specialists Dr. David Sugarbaker and Dr. Raja Flores, found that patients who received EPP surgery had a median survival time of 19 months. However, some studies show that patients can survive up to 2 years with this procedure.
Pleurectomy With Decortication
Eligible patients with pleural mesothelioma may also undergo the lung-sparing surgery pleurectomy with decortication.
During this procedure, doctors only remove:
- Visible tumors
- The diseased parietal pleura
- The diaphragm
- Part of the pericardium
- Some lung tissue, if necessary
P/D is considered to be less aggressive than the EPP because it allows patients to keep both lungs, giving them a better quality of life after surgery. Additionally, P/D patients develop fewer fatal complications within 30 days after surgery compared to those who undergo EPP.
The median life expectancy of patients who receive P/D is around 29 months.
Peritoneal Mesothelioma Surgery
There is one main curative surgery for peritoneal mesothelioma, called cytoreduction with HIPEC.
Cytoreduction With HIPEC
Developed by Dr. Paul Sugarbaker, cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) is a curative treatment that has two parts: cytoreductive surgery and heated chemotherapy.
Cytoreductive surgery, also called debulking, involves the surgical removal of the entire diseased peritoneum (abdominal lining) and any tumors or diseased tissue surrounding the abdominal cavity.
Directly after the surgical removal of tumors, doctors will administer HIPEC (heated chemotherapy drugs) directly into the abdomen for up to 90 minutes. This helps kill off any remaining mesothelioma cells and prevent regrowth.
According to the National Cancer Institute (NCI), patients with peritoneal mesothelioma who receive cytoreduction with HIPEC may survive up to 7 years or more after diagnosis.