Surgery for Mesothelioma: Types of Surgery

Mesothelioma is a cancer that develops in the thin layer of tissue lining the lungs, chest wall, abdomen, or heart. For many patients, surgery is one part of a broader treatment plan that may also include chemotherapy, radiation, or newer therapies. The type of surgery recommended depends on where the tumor is located, how far it has spread, and the patient's overall health. This page explains the main surgical options in plain terms.

When Surgery Is Considered

Doctors typically consider surgery when mesothelioma is found early and has not spread widely. Before recommending an operation, a surgeon will review imaging scans, biopsy results, and the patient's lung and heart function. Surgery for mesothelioma is often described as either curative-intent, meaning the goal is to remove as much cancer as possible, or palliative, meaning the goal is to relieve symptoms and improve quality of life. No surgeon can guarantee an outcome, and every case is different.

Pleurectomy with Decortication (P/D)

Pleurectomy with decortication is the most common lung-sparing surgery for pleural mesothelioma, which affects the lining of the lungs. During this procedure, the surgeon removes the diseased pleura, the membrane surrounding the lung, along with any visible tumor. The lung itself is left in place. Because the lung is preserved, recovery is often easier than with more extensive surgery, and many patients retain better breathing function afterward. P/D is frequently combined with chemotherapy or radiation to target any remaining cancer cells.

Extrapleural Pneumonectomy (EPP)

Extrapleural pneumonectomy is a more extensive operation. In addition to removing the pleura and visible tumor, the surgeon removes the entire affected lung, part of the diaphragm, and the lining of the sac around the heart. Because this is a major procedure, it is only offered to patients who are strong enough to tolerate it and whose cancer has not spread beyond one side of the chest. EPP carries a longer hospital stay and a more demanding recovery period. In recent years, many surgical teams have moved toward P/D when possible, reserving EPP for select cases.

Debulking and Palliative Procedures

When a full removal is not possible, surgeons may perform debulking, which means removing as much tumor as feasible to reduce pressure on the lungs or abdomen. For peritoneal mesothelioma, which affects the lining of the abdomen, a procedure called cytoreductive surgery is often paired with heated chemotherapy delivered directly into the abdomen. For patients who need symptom relief, a surgeon may also place a small tube, called a catheter, to drain fluid that builds up around the lungs or in the belly. These palliative steps can ease breathing and discomfort without the risks of major surgery.

Recovery and What to Expect

Recovery from mesothelioma surgery varies widely. Lung-sparing procedures generally mean a shorter hospital stay, while an EPP may require weeks of recovery and rehabilitation. Patients typically need help at home during the first weeks after discharge. Pain management, breathing exercises, and gradual physical activity are all part of the healing process. The surgical team will provide specific instructions, and patients should ask questions about what to expect before and after the operation.

Finding Care in Missouri

Missouri residents have access to several hospitals and cancer centers that treat mesothelioma, including academic medical centers in St. Louis and Columbia. A patient's primary care doctor or oncologist can help arrange a consultation with a thoracic surgeon who specializes in this disease. It is reasonable to seek a second opinion before making a decision, as surgical expertise and hospital experience can influence outcomes. Patients should also discuss insurance coverage, travel needs, and support services with the care team.

Choosing whether to have surgery is a personal decision that depends on many factors. Patients and families are encouraged to ask their doctors about the risks, benefits, and goals of each surgical option so they can make an informed choice that fits their situation.

This page is for general informational purposes only and is not legal or medical advice. Reading it does not create an attorney-client relationship. Consult a licensed attorney or physician about your specific situation.