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Surgery for Mesothelioma
Surgery might be an option to help treat some people with mesothelioma, although it’s not likely to be helpful for everyone. In general, mesothelioma is hard to remove completely because of where it starts and how it grows and spreads.
When might surgery be used for mesothelioma?
Surgery is most likely to be helpful for mesotheliomas of the epithelioid subtype that haven’t spread extensively. It’s less likely to be helpful for sarcomatoid or mixed/biphasic subtypes.
If surgery is an option, the type of surgery you get depends on whether the mesothelioma is pleural mesothelioma, peritoneal mesothelioma, or mesothelioma of the tunica vaginalis, among several other factors.
Because it’s very hard to remove all the cancer, surgery is rarely the only treatment for mesothelioma. Most often it’s followed by chemotherapy and/or other medicines, and possibly radiation therapy. Sometimes, chemotherapy or immunotherapy might be given first to try to shrink the cancer before surgery.
Surgery as part of the initial treatment
Surgery might be an option if you're in otherwise good health and the surgeon believes all visible cancer can be removed (resected) completely. But even when the surgeon removes all the cancer that can be seen, some cancer cells are often left behind. These cells can grow and divide, causing the cancer to come back after surgery.
Because of this, not all doctors agree on the exact role of surgery in treating mesothelioma. In most cases it’s not likely to lead to a cure. It might help you live longer, but this isn’t clear from studies. It also needs to be weighed against its possible side effects.
Still, surgery is being done in some major cancer centers and a small number of people who have had the surgery have had long periods of time with no sign of cancer.
Surgery to help with symptoms
Surgery might also be an option to help prevent or relieve symptoms, even if it can’t be removed completely. This is known as palliative surgery.
Surgery for mesothelioma is a complex operation. If it might be an option for you, it’s very important that it’s done by a surgeon at a center that has experience in treating mesothelioma.
Surgery for pleural mesothelioma
Most often, pleural mesothelioma has spread too far to be removed completely. Sometimes, the surgeon might not be able to tell the full extent of the cancer – and not know which type of surgery might be best – until the operation has started.
This is the most common operation to try to remove the cancer. In this surgery, the pleura lining the chest wall and the lung on the side with the cancer is removed. The pleura covering the mediastinum (the space between the lungs) and the diaphragm (the thin, dome-shaped muscle separating the chest from the abdomen) is also removed.
In a slightly more extensive version of this operation, called a radical or extended P/D, the diaphragm on the side with cancer and/or pericardium are removed. Then, they are then rebuilt with man-made materials.
This surgery can be used to try to cure some early cancers. It can also be used as a palliative procedure to relieve symptoms if the entire tumor can’t be removed. It can often help control fluid buildup, improve breathing, and lessen pain caused by the cancer.
This is a more extensive operation. It might be used if the surgeon thinks a cure is possible in some people with resectable epithelioid mesothelioma. However, studies haven’t shown that EPP is more likely to result in a cure than P/D. It’s also more likely to cause serious side effects, so it’s not used as often as P/D.
In an EPP, the surgeon removes the:
- Lung on the side of the cancer along with
- Pleura lining the chest wall on that side
- Diaphragm (thin breathing muscle) on that side
- Pericardium (the sac around the heart), possibly
- Nearby lymph nodes.
The diaphragm and the pericardium are then rebuilt with man-made materials.
This is a complex operation that's only done by experienced surgeons in large medical centers. You must be in good overall health with good lung function and no other serious illnesses to withstand EPP. A lot of tests must be done beforehand to be sure you’re healthy enough for this surgery.
About 1 in 3 people who have this operation have major complications.
The goal of this surgery is to remove as much of the cancer as possible. In general, less tissue is removed in this operation than in a P/D procedure.
Possible side effects
Because the surgeon must often spread the ribs during surgery, the incision will hurt for some time afterward. Your activity will be limited for at least several weeks.
Surgery to treat pleural mesothelioma can have serious risks and side effects, which are more likely with EPP. The risks depend on the extent of the surgery and the person’s health beforehand. Serious complications can include:
- Bleeding
- Blood clots
- Wound infections
- Changes in heart rhythm
- Pneumonia
- Fluid build-up in the chest
- Loss of lung function
Serious side effects tend to be less common with less extensive operations, but they’re still possible.
Surgery for peritoneal mesothelioma
Surgery for peritoneal mesothelioma can be used to help ease symptoms or to remove the tumor from the wall of the abdomen and digestive organs. As with pleural mesothelioma, these tumors often have spread too far to be removed completely.
The goal of this surgery, also known as cytoreductive surgery, is to remove as much of the mesothelioma as possible. Sometimes this means removing other organs, such as the spleen or pieces of the intestine as well.
Sometimes an omentectomy is part of this operation. The omentum is an apron-like layer of fatty tissue that drapes over the organs inside the abdomen. Cancers in the peritoneum often spread to this tissue, so it might be removed as part of surgery.
After the visible cancer is removed but before the operation is finished, chemotherapy might be put into the abdomen. This is called intraoperative or intraperitoneal chemotherapy.
If the chemotherapy drugs are heated, it's called heated intraperitoneal chemotherapy or HIPEC. The drugs are left in for a short time, then they're removed and the incision is closed.
Some laparoscopic (keyhole) procedures can be used to help control the disease and reduce fluid buildup in the abdomen, known as ascites. These procedures are done through small incisions in the belly, so they’re less invasive than open surgery.
- Laparoscopic HIPEC: Laparoscopic surgery is used to put heated liquid chemotherapy into the abdomen for a short time and then remove it.
- Pressurized intraperitoneal aerosol chemotherapy (PIPAC): A laparoscopic procedure in which chemotherapy is sprayed as an aerosol mist into the abdomen under controlled pressure.
Surgery for pericardial mesothelioma
Surgery can remove a mesothelioma from the pericardium (the sac around the heart). The entire pericardium might be removed in a surgery called a pericardiectomy.
Sometimes, a less extensive surgery might be done to make a hole in the pericardium, which is called a pericardial window. This can help keep excess fluid from building up in the area around the heart and help relieve symptoms.
Surgery for mesothelioma of the tunica vaginalis
Most of the time, surgery for mesothelioma of the tunica vaginalis, which covers the testicles, is done when the tumor is mistaken for a hernia. The surgeon only realizes that it’s a mesothelioma after the surgery has begun.
The surgeon might need to do a more complete cancer surgery to try to remove it completely.
More information about surgery
For more general information about surgery as a treatment for cancer, see Cancer Surgery.
To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
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Last Revised: February 3, 2026
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