Treatments for mesothelioma include chemotherapy, radiation, and surgery. Chemotherapy uses medication to treat cancer. Radiation uses machines to physically destroy tumors. Surgery involves an operation where a doctor goes in and removes some or all of the cancer.

In many cases, once mesothelioma is found it is too late to perform surgery. However, in many cases surgery is the best option to remove as much of the cancer as possible. For example, in pleural mesothelioma the surgeon may remove parts of the lining around the lungs. This is called a pleurectomy. In many cases, though, the cancer cannot be completely removed. After surgery, other methods such as chemotherapy or radiation can be used to remove more of the cancer.

Why Is Surgery Important for Mesothelioma?

When a doctor recommends surgery for mesothelioma, he or she may have a few things in mind. The surgery can be used as a curative approach, which means that it is meant to remove tumors and increase the length of a person’s life. It can also be used for palliative care. This means it is designed to improve a person’s quality of life by lowering pain or helping symptoms. Finally, it can be used for diagnosis. This means that the doctor will perform surgery to look at the tumors and get a better idea of how extensive they are.

The question of whether or not to use surgery to treat mesothelioma depends on a host of factors (Table). Doctors and patients work together to make the best decision for treatment.

Table: Factors that Affect the Decision to Choose
Surgery for Mesothelioma

Type of cancer
Location of cancer
Severity of cancer
Side effects that may occur
Patient and family preferences
Patient overall health

New Developments in Mesothelioma Surgery

There has been a lot of recent research on surgery for mesothelioma, and studies are being published rapidly. They include research on who might be appropriate for surgery, what techniques a doctor should use, when to choose surgery over other treatments, and many others.

One of these new studies was published in November of 2015. The study looked at Ki-67, which is a tiny molecule inside of the body. Ki-67 helps tell doctors about cancer proliferation, meaning that the level of Ki-67 can help doctors tell how much or how little the cancer is spreading. Some research has looked at Ki-67 and found that high levels were related to more difficult treatment in patients with mesothelioma.

The study from November is the first one looking specifically at patients receiving surgery for mesothelioma. In this study the authors wanted to see if high or low levels of Ki-67 were related to how long a patient lives after surgery – termed survival. They looked at 117 patients with peritoneal mesothelioma, or cancer in the abdomen. In their article, the authors wrote:

“Ki-67 is a powerful prognosticator that allows, along with PCI [peritoneal cancer index], and histological subtype, a good prediction of OS [overall survival] in patients with DMPM [diffuse malignant peritoneal mesothelioma].”

What this means is that the level of Ki-67 in the body was important for helping them see who might best respond to surgery and how long they will live after surgery. They found that patients with high levels of Ki-67 may not be good candidates for surgery. Research of this type is very important for making treatment decisions for patients with mesothelioma.

Surgery and Mesothelioma – Moving Forward

Many factors determine how well a patient does after his or her surgery. These include the list in the table above. In the study above, the authors found that three factors had a strong effect on how long a patient lives after surgery. Ki-67 was one of these, and the best candidates for surgery had a low Ki-67 score. The research said that patients who had levels of Ki-67 that were above 9%, along with PCI scores above 17 (PCI is a test used by doctors to look at the severity of cancer in the abdomen) had lower survival and were not good candidates for surgery.

Research like this is important for doctors and patients thinking about surgery for mesothelioma. With growing information like this, doctors are learning which patients might respond well to surgery. This will ultimately help them make decisions together with their patients on which mesothelioma treatment option might be best.