Surgery for Malignant Mesothelioma

Surgery for malignant mesothelioma can be aimed at long-term control (aggressive surgery) or relief of symptoms (palliative procedures). Surgery is by no means a cure against the disease; rather it is used to hopefully prolong survival.

Aggressive Surgery – The most common aggressive surgery procedure is an "extrapleural pneumonectomy," which is the removal of the pleura, the lung, the diaphragm and the pericardium. The objective of this very complicated and aggressive surgical procedure is to remove as much of the tumor on the mesothelium as possible. Because of the highly specialized nature of this surgery and because it carries a high risk of death within 30 days of the surgery, not all hospitals can perform this procedure. Patients are carefully evaluated to determine their ability to tolerate the surgery, thus extrapleural pneumonectomy is generally performed only in younger patients in good overall health with the cancer in its early stages (Stage I).

Palliative Surgery – These surgical procedures are performed to relieve and/or control symptoms associated with advanced malignant mesothelioma. Lung function often is reduced in these patients because of pleural effusion (fluid collection) or when the tumor mass compresses the lung. This can lead to symptoms such as breathlessness and chest pains.

"Thoracentesis" is commonly performed to treat effusion in pleural mesothelioma. This surgery involves inserting a needle into the chest to drain the excess fluid, relieving breathlessness and chest pain. Talc may be introduced into the pleura to limit recurrence of the effusion.

"Pleurectomy" is the surgical removal of the pleura. This procedure is performed to reduce pain caused by the tumor mass, or to prevent the recurrence of pleural effusion. For peritoneal mesothelioma, surgery generally is aimed at relieving symptoms, such as recurrent ascites or bowel obstruction. As with pleural mesothelioma, complete surgical removal of the entire tumor is unlikely.