Mesothelioma Surgery

The two main operations for pleural mesothelioma differ in how much tissue is removed. Pleurectomy with decortication removes the pleural lining from the chest wall and the surface of the lung, along with visible tumor, while keeping the lung itself. In an extended version, surgeons may also remove and rebuild parts of the diaphragm and the sac around the heart. Extrapleural pneumonectomy removes the entire lung on the affected side, together with the lining, and usually parts of the diaphragm and pericardium. Many centers now prefer lung-sparing surgery when it can achieve a similar result, because living with both lungs is generally easier. The best choice depends on the tumor's spread, lung function and the surgical team's experience and approach.

For peritoneal mesothelioma, the main operation is cytoreductive surgery, often abbreviated CRS. Surgeons carefully explore the abdomen and remove all visible tumor, which may include the omentum, portions of the peritoneal lining and sometimes parts of organs such as the bowel or spleen if they are involved. When cytoreduction is complete, many centers then perform HIPEC, circulating heated chemotherapy through the abdomen for a set period before closing. The operation can take many hours. Its success depends heavily on how much disease is present and whether all visible tumor can be removed. Because it is complex, CRS with HIPEC should be performed at centers that do it regularly and have teams trained to manage the recovery.

Deciding who should have major mesothelioma surgery involves weighing likely benefit against risk. Surgeons look at how far the disease has spread, often using CT, PET-CT and sometimes a scope procedure to look inside the chest or abdomen. They consider cell type, since epithelioid disease is more often treated surgically than sarcomatoid disease. Lymph node involvement may also affect the decision. Fitness matters greatly: heart and lung tests show whether a patient can tolerate a long operation and recovery. Age alone does not rule anyone out, but overall health does. Some patients start with chemotherapy or immunotherapy before surgery is considered. If one surgeon says surgery is not possible, a second opinion from a high-volume center is often worthwhile.

Before a major operation, teams often recommend a period of preparation sometimes called prehabilitation. Walking, breathing exercises and light strength training can build stamina for recovery. Good nutrition helps wound healing, so a dietitian may suggest extra protein or supplements, especially if you have lost weight. Stopping smoking, controlling blood sugar and reviewing medicines such as blood thinners are common steps. At home, plan for several weeks when lifting, driving and household tasks will be limited. Arrange who will stay with you, set up a comfortable space on one floor if possible, and stock easy meals. Ask the surgical team for a written list of pre-operation instructions, including when to stop eating and which medicines to take.

Recovery from major mesothelioma surgery is gradual. Patients usually spend time in intensive care or a monitored unit at first, followed by several more days or longer on a surgical ward. Chest tubes or abdominal drains may stay in place for a while. Pain control, breathing exercises and early walking help prevent complications such as pneumonia or blood clots. Common challenges after discharge include fatigue, reduced appetite, shortness of breath and discomfort around the incisions. Most people need weeks to months before energy returns, and further treatment such as chemotherapy or radiation may follow once healing allows. Ask the team which warning signs require an urgent call, such as fever, increasing breathlessness, wound redness or severe abdominal pain.