Surgery for mesothelioma may be done for 1 of 2 reasons: to try to cure the cancer or to relieve (palliate) pain and other symptoms caused by the tumor.

Potentially curative surgery

Potentially curative surgery may be an option if you are in otherwise good health and the tumor is thought to be localized and can be removed completely. Unfortunately, mesothelioma cells tend to spread into the chest wall, around the heart, over nerves, and the diaphragm. It is often difficult to detect this spread and remove these cells. Because of this, not all doctors agree on the exact role of surgery. In most cases it is not likely to cure you but may extend your life. Still, potentially curative surgery is being done in some major cancer centers, and a few patients who have had the surgery have had long remissions of their disease.

Two surgical procedures may be options if you have pleural mesothelioma:

Extrapleural pneumonectomy: This is an extensive operation that attempts to remove all or most of the cancer and some surrounding tissues as well. It is most often used in patients with localized mesothelioma of the epithelioid type, when the surgeon thinks a cure is possible. The operation removes the pleura lining the chest wall, diaphragm, and pericardium, as well as the whole lung on the side of the tumor. The diaphragm and the pericardium are then reconstructed with man-made materials. This is a difficult operation and is done only by surgeons in large medical centers. You must be in good overall health with good lung function and no other serious illnesses to tolerate this surgery. Major complications occur in as many as 1 in 4 people who have this operation.

Pleurectomy/decortication: Pleurectomy/decortication is a less extensive operation. This procedure removes the pleura, where the majority of the tumor is located. While it may be used to try to cure some cancers, it is more often used as a palliative procedure to relieve symptoms in cases where the entire tumor cannot be removed. It can help control the buildup of fluid, improve breathing, and decrease pain caused by the cancer.

Palliative surgery

Palliative surgery may be an option if the tumor has already spread beyond the mesothelium and is difficult to remove completely, or if you are too ill for a more extensive operation. The goal of this surgery is to relieve or prevent symptoms, as opposed to trying to cure the cancer.

For pleural mesotheliomas, pleurectomy/decortication (described above) is the most common type of palliative surgery. But in many cases, even this surgery may be too much for a patient to tolerate.

Surgical treatment of peritoneal mesothelioma is often done either to help relieve symptoms or to remove the tumor from the wall of the abdomen and other digestive organs. As with pleural mesothelioma, these tumors are often too extensive to remove completely. Similar operations can be done to remove a mesothelioma from the pericardium (the sac around the heart).

Surgery for mesothelioma of the tunica vaginalis testis, which occurs in the groin, is also not usually curative. Most of the time surgery is done because the tumor resembles a hernia. The surgeon attempts to treat a suspected hernia and only realizes the diagnosis after the surgery is begun. This kind of mesothelioma typically can't be removed entirely.

Other palliative procedures

Several less invasive procedures can be used to control some of the symptoms caused by mesotheliomas, especially those due to the buildup of fluid.

Thoracentesis/paracentesis/pericardiocentesis: In these procedures, a doctor uses a long, hollow needle to remove excess fluid from a body cavity. While they are described in the section, "How is malignant mesothelioma diagnosed?", they can be done to provide relief from symptoms caused by fluid buildup, such as shortness of breath. The major drawback with these techniques is that they often need to be repeated.

Pleurodesis: This procedure may be done to try to prevent fluid from building up in the chest cavity. A small cut is made in the skin of chest wall, and a hollow tube is placed into the chest to remove the fluid. Either talc or a drug such as doxycycline or a chemotherapy drug is then instilled into the chest cavity. This causes the linings of the lung (visceral pleura) and chest wall (parietal pleural) to stick together, sealing the space and preventing further fluid buildup. The tube is generally left in for a day or two to drain any new fluid that might accumulate.

Shunt placement: This approach may be used if pleurodesis or other techniques are not effective. A shunt is a device that enables fluid to move from one part of the body to another. For example, a pleuro-peritoneal shunt allows fluid in the chest to move into the abdomen, where it is more likely to be absorbed by the body. The shunt is a long, thin, flexible tube with a small pump in the middle. In the operating room, the doctor inserts one end of the shunt into the chest cavity and the other end into the peritoneum. (The pump is placed just under the skin over the ribs.) Once the shunt is in place, the patient uses the pump several times a day to move the fluid from the chest to the abdomen.

Catheter placement: This is another approach sometimes used to control the buildup of fluid. One end of the catheter (a thin, flexible tube) is placed in the chest or abdomen and the other end is left outside the body. This is done in a doctor's office or hospital. Once in place, the catheter can be attached to a special bottle or other device to drain out the fluid on a regular basis.

Last Medical Review: 03/17/2009
Last Revised: 03/17/2009