The possible operations for pleural mesothelioma are
* Extrapleural pneumonectomy
* Pleurectomy
Surgery is not suitable for everyone and won't cure your mesothelioma. The aim of the operation is to try and keep the disease under control and enable you to stay well for as long as possible. If you are having major surgery for mesothelioma, it should be as part of an overall treatment plan that includes radiotherapy and chemotherapy as well. From what we know from research so far, this is the best way to try to control mesothelioma for as long as possible.
Mesothelioma is often diagnosed too late to make a big operation worthwhile. If pleural mesothelioma is diagnosed early enough, you may be able to have an extrapleural pneumonectomy. If the cancer has already spread, a pleurectomy can help to control symptoms. But it will not cure your mesothelioma and may not actually make any difference to how long you live.
An operation can help some people who have peritoneal mesothelioma. This operation can only be done if it is diagnosed early enough.
There is more about what happens before and after surgery in this section of CancerHelp UK.
Extrapulmonary pneumectomy(EPP)
This is major surgery. It means removing the lung on the affected side. The pleura, diaphragm and covering of the heart (pericardium) are also removed.
EPP is not suitable for everyone with pleural mesothelioma. You need to be fit enough to walk up and down two flights of stairs without becoming breathless. Your cancer must be at an early stage. This means that is must not have spread to lymph nodes, or be growing into any other major body parts outside the lung.
To do the operation, your surgeon will open your chest, either at the front or at the side. An opening at the side is called a thoracotomy. An opening at the front is called a sternotomy. You will have a wound about 9 inches long. You will have to stay in hospital for about 2 weeks afterwards. It will take you about 6 to 8 weeks to fully recover.
This major surgery cannot cure your mesothelioma. But it can help you to live longer. The people who have lived longest after a diagnosis of mesothelioma have had this operation, together with chemotherapy or radiotherapy. You and your family need to understand that this is a very big operation and has risks. About 6 or 7 out of every 100 people who have this particular operation die during or just after the surgery.
Pleurectomy
You may be offered pleurectomy to help control symptoms. It can help to control fluid build up in the chest and relieve some chest pain. This is a major operation, but can be done using keyhole surgery. If you have keyhole surgery you will have 3 wounds, each about an inch long (2cm).
The surgeon will take away as much of the tumour as possible. This means removing the outside covering of the lung - the pleura - on one side on one side of the chest. You will have to stay in hospital for about 7 days afterwards. It will take you about 3 to 4 weeks to fully recover.
Surgery for peritoneal mesothelioma
Surgery is not possible for everyone with peritoneal mesothelioma. If surgery is possible, the operation is called a peritonectomy. This means removing the peritoneum (the lining of the abdomen). In recent years some doctors have been developing a technique known as cytoreductive surgery for peritoneal mesothelioma. Cytoreductive surgery involves the surgeon carrying out up to 6 different peritonectomy procedures, to remove as much of the cancer as possible. Then chemotherapy may be given straight into the peritoneal cavity. Some studies have suggested that this can work better if it is heated to a few degrees above body temperature first. This is called hyperthermic intraoperative intraperitoneal chemotherapy (HIIC). Doctors have achieved some promising results using these techniques; in one review, about half of the patients who had been treated in this way were still alive 5 years after. But this is still very experimental treatment and, if it is available, may only be so as part of a clinical trial.
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