Surgery is performed to make a diagnosis, to relive symptoms, or to improve survival in a select group of mesothelioma patients. Depending on the extent to which the cancer has spread, doctors will make a determination as to the appropriate treatment. In many cases, mesothelioma surgery can be performed here in Hawai‘i. In other cases, Hawai‘i patients may fly to the mainland to be treated by specialists at national mesothelioma treatment centers.

If the cancer is localized on the pleura or peritoneum, it is considered to be in the early stages. Generally, the outlook is better of the cancer is diagnosed in the early stages. This is why it is important to get regular checkups if you know you have been exposed to asbestos.

Pleurectomy or Decortication

Patients with mesothelioma in its early stages maybe candidates for removal of part of the pleura or peritoneal lining and some of the tissue around it. A pleurectomy is a surgery to remove part of the pleural lining of the lungs and chest. Often this is done together with a decortication to remove the outside surface of the lungs or diaphragm as well. The goal of a pleurectomy is to peel away the tumor while leaving the lungs and diaphragm intact. This usually allows a patient to regain their lung function after the surgery.

However, in most cases, the tumor cannot be completely removed via pleurectomy. In addition, the doctor cannot give high doses of radiation to the chest after the surgery, because this could seriously damage the intact lung and diaphragm. Therefore, the tumor is significantly more likely to recur after a pleurectomy than after more radical surgery in which the entre lung is removed. Doctors will often perform a pleurectomy/decortication as a palliative treatment for patients who cannot tolerate the more radical surgery called as extrapleural pneumonectomy.

Extrapleural Pneumonectomy (EPP)

Extrapleural pneumonectomy (EPP) is a radical surgery used to treat pleural mesothelioma. The goal of EPP is to remove the entire mesothelioma tumor from the body. The thoracic surgeon will remove an entire lung and lymph nodes on one side, as well as part of the pleura and diaphragm. Often the pericardial lining of the heart is removed as well. The diaphragm and pericardium are then reconstructed with an artificial material.

EPP is most often used in the early stages of mesothelioma when the cancer is still localized. This type of surgery is most successful when it is combined with other treatments such as radiation or chemotherapy.

EPP is a very difficult operation, and should only be performed by an expert surgeon. Patients must be in good physical shape to tolerate the procedure. The recovery is long and painful, and there can be major complications. However, if your doctor tells you that you are a good candidate for surgery, an EPP may offer the best chance of complete tumor removal.