Surgery can be a large part of a patient’s experience with mesothelioma. Diagnostic surgery may be needed to obtain a biopsy to diagnose the cancer and therapeutic surgery to remove tumors to slow the spread of cancer. Palliative surgery may also be employed to make patients feel more comfortable.
Medically Reviewed By:
Patricia Shelton, M.D.
Medically Reviewed By:Patricia Shelton, M.D.
Mesothelioma treatment may include various types of surgical procedures. In some cases, the biopsy that’s needed for the diagnosis may be obtained via a surgical procedure. Tumor-removing surgery may extend life in carefully selected patients, although not everyone is eligible.
Diagnostic Surgery for Mesothelioma
As part of the process of mesothelioma diagnosis, a biopsy is needed. This is a small sample of tissue that can be examined under a microscope by a pathologist. In certain cases, the necessary cells can be obtained through a minor procedure that is generally performed outside of the operating room.
Therapeutic Surgery for Mesothelioma
Certain patients may be candidates for therapeutic surgery, also known as tumor-removing surgery. In this type of procedure, the surgeon aims to remove as much of the cancer as possible, using different techniques for different types of mesothelioma. This is sometimes also known as potentially curative surgery, although mesothelioma is generally considered incurable. These procedures may extend life but are very unlikely to get rid of the cancer entirely.
Not all patients are candidates for these procedures. Patients must be in good overall health to be able to undergo a very invasive surgery. Additionally, certain characteristics of the tumor will determine whether surgery is a good option. Those with epithelioid tumors in an early stage are most likely to benefit.
For a surgeon, these are very technically demanding procedures. Because mesothelioma is relatively rare, most surgeons have not performed them very often. Receiving your treatment at a cancer center will give you access to a surgeon with the necessary experience to get the best possible results from the surgery.
Surgery is rarely used alone to treat mesothelioma. Rather, it’s generally part of a multimodality treatment plan, which may also include chemotherapy, radiation therapy, and/or immunotherapy. There are also a number of current clinical trials that involve testing the combination of other treatments with surgery, and some patients may choose to participate.
Each patient must make their own decisions about their cancer care. Research has shown that, in carefully selected patients, surgery can extend survival, which can buy more time with loved ones. At the same time, these are very invasive procedures, and patients will have lasting side effects from them. Some patients decide that they would rather focus on palliative treatment options rather than go through a major surgery.
Pleural Mesothelioma Surgery
Only patients with resectable tumors are candidates for tumor-removing surgery. Early-stage malignant pleural mesothelioma (stages 1 or 2) is generally considered resectable, and some stage 3 tumors may be resectable as well. Once the cancer has spread to lymph nodes or undergone metastasis, surgery is no longer an option. Additionally, patients with sarcomatoid tumors are not eligible for surgery because research has not shown a survival benefit for these patients.
In the past, the survival rates were higher with EPP than with P/D. However, due to advances in technique, the survival after P/D is now equivalent to that after EPP, and some studies have even reported that it’s slightly better. The median survival time after EPP is about 16 months, while after P/D, it’s about 22 months. Additionally, patients generally have a better quality of life following P/D because the lung is not removed.
Peritoneal Mesothelioma Surgery
In general, there’s one type of surgery that’s preferred for patients with peritoneal mesothelioma. Patients with epithelioid tumors whose disease has not metastasized are generally candidates for this procedure, which is called cytoreductive surgery (CRS). The surgeon removes as much tumor tissue as possible from the abdomen, a process known as debulking.
This generally involves removing many parts of the peritoneum (the membrane around the digestive system), and sometimes other organs, such as the gallbladder, spleen, and/or parts of the intestine. The specifics of the tissue removal depend on where visible tumors are present.
Hyperthermic intraperitoneal chemotherapy (HIPEC) is usually also used as part of the procedure. After CRS, a heated solution of chemotherapy drugs is infused into the abdominal cavity, left for a period of time, and then washed out. The combined procedure is known as CRS-HIPEC.
CRS-HIPEC can offer a significant survival benefit in carefully selected patients. Some centers have reported 5-year survival of up to 44% following CRS-HIPEC. However, the procedure does carry a risk of mortality (up to almost 5%) and has significant side effects. Additionally, patients with sarcomatoid or biphasic tumors or whose cancer has already metastasized are not candidates for the procedure.