Surgery for pleural mesothelioma

Find out about surgery for mesothelioma in the chest (pleural mesothelioma).

Pleural mesothelioma starts in the layers of tissue that cover the lung (the pleura). Some people can have surgery to try to remove the mesothelioma. It can't usually get rid of the mesothelioma for good. The aim is to try and keep the disease under control and help you to stay well for as long as possible.

Types of surgery

Surgery can be used to try to completely remove the mesothelioma. There are 2 main types of operation for this. One type removes the pleura and is called a pleurectomy. The other type is called an extrapleural pneumonectomy. It removes the pleura together with the lung, part of the covering of the heart (the pericardium) and the muscle under the lungs (the diaphragm).

Removing the covering of the lung (pleurectomy)

This type of surgery is also called decortication. Your surgeon removes part or all of the pleura from around the lung. It can help to control symptoms such as breathlessness. It can also help to control fluid build up in the chest and relieve chest pain.

Removing part of the pleura

The surgeon removes the part of the lining of the lung (pleura) that contains the mesothelioma. It is called a partial pleurectomy.

This is a major operation that can sometimes be done using keyhole surgery. The surgeon makes 3 small wounds, each about an inch (2cm) long. They take away as much of the mesothelioma as possible. They also put a substance into the space to stop fluid building up in future.

Instead of keyhole surgery your surgeon might need to make a large wound in your chest.  

You need to stay in hospital for about 7 days afterwards. It takes about 4 to 6 weeks to fully recover.

Removing the whole pleura

This operation is called a total pleurectomy. The surgeon removes the whole pleura from around the lung on the affected side. They make a large wound in your chest called a thoracotomy and remove the pleura and then replace it with a specialised medical mesh layer.  

You have to stay in hospital for 10 to15 days afterwards. It takes about 6 to 8 weeks to fully recover.

This kind of operation is carried out in specialist hospitals in the UK.

Removing the lung and pleura

This type of surgery is called extrapleural pneumonectomy. It is not often used. It is only suitable for early stage mesothelioma that hasn't spread into the lymph nodes or grown into any other areas outside the lung.

This is a major operation. Between 5 to 10% of people die during or soon after the surgery. You usually have it together with chemotherapy or raiotherapy. The combination of treatments is very difficult to cope with. Your doctor will discuss the benefits and the risks very carefully with you beforehand. 

What happens

The surgeon makes a cut about 9 inches long into the side of your chest (a thoracotomy). They remove the lung on the affected side as well as the pleura, the muscle under the lung (diaphragm) and the covering of the heart (pericardium). 

You need to stay in hospital for at least 2 weeks afterwards. It can take around 3 to 4 months to fully recover.

Surgery for advanced mesothelioma

The surgery aims to remove as much tumour as possible to relieve symptoms. It is called palliative surgery or debulking. It can help to reduce breathlessness.

Clinical trials to improve treatment

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

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