Pleural Mesothelioma Surgery

Quick Summary

A major part of effective pleural mesothelioma treatment is surgery. Specialists remove tumors as well as diseased organs and tissues to help prevent metastasis (cancer spreading). Two curative surgical procedures for pleural mesothelioma can improve survival.

Pleural Mesothelioma Surgery Overview

If you’ve been diagnosed with pleural mesothelioma, then you likely have some surgical options available to you.

Here’s what you need to know about surgery for pleural mesothelioma:

  • Pleural mesothelioma can effectively be treated using surgery as part of a multimodal approach that includes chemotherapy and/or radiation therapy
  • Surgeries for pleural mesothelioma can be either curative (removing all visible signs of tumors) or palliative (improving quality of life)
  • Curative surgeries can be performed on stage 1 and 2 pleural mesothelioma patients
  • Palliative surgeries can be performed on late-stage pleural mesothelioma patients
  • Extrapleural pneumonectomy and pleurectomy with decortication are the standard curative surgeries for pleural mesothelioma
  • Mesothelioma specialists across the country are available to treat pleural mesothelioma patients with either of these surgical procedures

Goals of Pleural Mesothelioma Surgery

Depending on how far your condition has advanced at the time of diagnosis, doctors will identify different sets of treatment goals. These treatment goals reflect what doctors feel will be most effective either in extending the patient’s survival or improving their quality of life.

For example, the treatment goals of stage 1 and 2 pleural mesothelioma patients are much different than the treatment goals with patients who have advanced pleural mesothelioma.

Here are some of the possible treatment goals with pleural mesothelioma surgeries:

  • Remove all visible signs of tumors
  • Remove diseased tissues and organs
  • Stop and prevent metastasis
  • Prevent recurrence (when cancer comes back after being eliminated)
  • Alleviate painful symptoms

Depending on what the goals of treatment are, doctors will recommend either a curative or palliative surgery. Curative surgeries aim to remove as much of the tumor as possible in an attempt to “cure” the patient. Curative surgeries are then followed by chemotherapy and radiation therapy to kill off remaining cancer cells left behind after surgery. Curative surgeries are only performed on patients with early-stage mesothelioma when the cancer is still resectable (removable by surgery).

Palliative surgeries aim to eliminate or minimize the causes of painful symptoms. For example, pleural effusions appear in roughly 90% of pleural mesothelioma cases and can cause chest pain and difficulty breathing. Palliative surgeries can alleviate these symptoms by draining the fluid buildup (effusion) from the pleura.

Pleural Mesothelioma Surgery Options

Surgery Options Update

There are two standard pleural mesothelioma surgeries. While they are typically reserved for patients with stage 1 and 2 pleural mesothelioma, both have been performed on later stage patients in certain circumstances. Contentiously debated, the extrapleural pneumonectomy and the pleurectomy with decortication are two drastically different approaches to treating resectable pleural mesothelioma.


Extrapleural Pneumonectomy

The extrapleural pneumonectomy (EPP) was the first curative surgical technique developed for pleural mesothelioma. It’s a controversial procedure because it involves removing the diseased lung, which is not only risky but can impact patient quality of life. Dr. David Sugarbaker was the first to standardize this operation in the United States and has gone on to teach EPP to the next generation of surgeons. He believes that EPP, when performed in the right candidate, can not only be more effective at removing all signs of mesothelioma but is also the best option for preventing recurrence.

During EPP, the surgeon removes the following:

  • Entire diseased lung on the side of the chest where the tumor originated
  • Diseased pleura (lung lining and possibly part of the pleura in the chest wall)
  • Part of the diaphragm
  • Part or all of the pericardium (heart lining)
  • Nearby lymph nodes

Because the EPP is such as radical surgery that involves removing so many parts, it can only be performed on patients who are healthy enough to undergo the stresses of surgery. The average age of pleural mesothelioma patients is 65-70 years old, so many of these patients may not be physically fit enough to withstand surgery.

In patients who are deemed healthy enough for EPP, the results have varied. Some studies have shown that EPP can result in a survival time of 6.9 to 46.9 months when the median life expectancy is 12-21 months. When combined with other therapies, an EPP-based treatment produces a median life expectancy of 10-35 months.

Before the EPP was perfected like it is today, there was a high morbidity rate involved with the procedure—meaning there were often serious complications that occurred during surgery. Mortality rates for EPP have been as high as 31%. Today, perioperative mortality rates in patients undergoing EPP are between 2.2% and 7% thanks to advancements in surgical technology.

Pleurectomy with Decortication

The pleurectomy with decortication (P/D) was developed as a more conservative alternative to the EPP. Depending on who you ask, the P/D has its own controversial factors. The principle philosophy behind P/D is that allows the patient to keep their lung, which is believed to help improve their quality of life compared to the EPP procedure. According to Dr. Robert Cameron—the pleural mesothelioma specialist who standardized the P/D—this procedure takes away the unnecessary risks associated with EPP.

During the pleurectomy with decortication, the surgeon removes:

  • Diseased pleura (both the inner and outer layers)
  • Visible tumors around the pleura
  • Any diseased lung tissue, depending on how far the mesothelioma has metastasized

P/D is a highly technical surgery that takes several hours to complete. As with all complex operations, only patients who are healthy enough to undergo surgery will be eligible for the P/D. Generally, this will only include younger, healthier patients with stage 1 or 2 pleural mesothelioma.

Survival rates for the P/D vary greatly, much like the results in EPP. Multiple studies have shown a survival of up to 32 months. When the patient undergoes a multimodal treatment approach, a P/D-based treatment results in a median life expectancy of 8-22 months. Mortality rates for the P/D range between 1% and 5%.

EPP vs P/D Pleural Mesothelioma Surgeries

Pleural mesothelioma patients who are eligible for resectable surgery should closely look at the main differences between the extrapleural pneumonectomy and the pleurectomy with decortication. Here is a side by side comparison of the differences between EPP and P/D:

 

EPP P/D
Parts Removed
  • Lung
  • Pleura
  • Part of diaphragm
  • Pericardium
  • Lymph nodes
  • Pleura
  • Visible tumors
  • Possibly lung tissue
Average Survival  10-35 months  8-22 months
Mortality Rate  2-7%  1-5%
Hospital Stay  9 days  7 days
Rate of Recurrence  33%  65%

You are fully within your right to obtain a second opinion from another pleural mesothelioma specialist if you aren’t sure which procedure is right for you. Once you’ve thoroughly examined all of your options, it may become clear which surgical procedure is right for you. While it’s a controversial choice, studies consistently show there is no one clear benefit to one over the other, and rather the choice depends entirely on the particular case at hand.

Seeking Compensation for Pleural Mesothelioma Surgeries

If you’ve been diagnosed with pleural mesothelioma, then there are important and potentially life-saving treatment options available to you. Most patients require a combination of surgery, chemotherapy and radiation therapy to ensure the most effective treatment approach.

It’s critical for all mesothelioma patients to be treated by specialists operating out of the country’s top cancer centers. Contact Mesothelioma Help Now today to learn more about the top mesothelioma specialists near you. Our Patient Advocates are waiting to review your case and answer any questions you may have about treatments and how to obtain legal compensation for your diagnosis.