Surgery for pleural mesothelioma
Surgery for pleural mesothelioma is usually done either to diagnose the cancer or help relieve symptoms.
Surgery to try to remove mesothelioma or help people live longer is called radical surgery. Radical surgery is only possible in a very small number of people with mesothelioma. This is mainly because mesothelioma is often found at an advanced stage. Because it is major surgery, you also need to be well enough to have the surgery.
These major operations are done by specialist chest surgeons (thoracic surgeons) who are experienced in treating mesothelioma. Sometimes, surgery may be done as part of a clinical trial.
This is when the surgeon removes only the pleura that contains mesothelioma cells. They do not remove any lung tissue. Removing the outer pleura is called a pleurectomy. Removing the inner pleura is called a decortication. Depending on the stage of mesothelioma, you may have both layers removed. This operation is called a pleurectomy decortication, or PD.
Sometimes, surgeons do a smaller operation to remove only some of the pleura (partial pleurectomy). This can help with symptoms, for example it can help reduce the build-up of fluid in the pleura (pleural effusion), or to re-expand the lung.
It may be possible to have the partial pleurectomy using keyhole surgery. During this operation, the surgeon makes several small openings instead of one large cut. The other types of surgery are usually performed through one large cut that goes from your side below your armpit round to your back below your shoulder blade (thoracotomy).
For more advanced mesothelioma, as well as removing the pleura, the surgeon may also have to remove other nearby areas. These can include:
- part of the covering of the heart (pericardium)
- lung tissue
- the muscle between the lung and the tummy (diaphragm).
This is called an extended pleurectomy decortication (EPD). The surgeon will then reconstruct the pericardium and diaphragm. This is major surgery and you must be well enough to have it.
If surgery is a suitable treatment for you, your specialist will tell you more about what to expect.
We have more information about mesothelioma treatment.
Below is a sample of the sources used in our mesothelioma information. If you would like more information about the sources we use, please contact us at email@example.com
Woolhouse I et al. British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma. Thorax. 2018.
Thomas A et al. Mesothelioma. BMJ Best Practice. 2019.
Baas P et al. Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 26 (Supplement 5): v31–v39. 2015. Available from: www.pubmed.ncbi.nlm.nih.gov/26223247
Kusamara S et al. Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up. European Journal of Surgical Oncology. March 2020.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr David Gilligan, Consultant Clinical Oncologist.
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