Mesothelioma Treatment Options - Surgery

There are two main types of surgical treatment for pleural mesothelioma: extra-pleural pneumonectomy (EPP) and pleurectomy/decortication.

EPP involves the removal of the pleura, diaphragm, pericardium, and the whole lung involved with the tumor. Pleurectomy/decortication involves the removal of the pleura without removing the entire lung.

Which treatment is recommended depends on many factors, including the stage of the tumor. (The NCI has a detailed description of mesothelioma stages.) However, it is unclear if EPP provides significantly greater benefits than pleurectomy/decortication, and indeed if either is significantly more effective than non-surgical options.

A recent study followed about 400 mesothelioma patients who, between 1983 and 1998, had pleurectomy/decortication, or extra-pleural pneumonectomy (EPP), or thoracotomy. The results indicate that no one type of surgery was more effective than another in extending the survival rate. Rather, other factors seemed to determine how long people survived. These factors included the stage and cell type of the tumor, the gender of the patient, and the type of treatment(s) given together with the surgery. Click here for the text of this study.

Surgery can provide symptomatic relief and sometimes the bulk of the tumor can be removed. Surgery is often used in combination with other treatments (known as multi-modal treatments), but its value is very limited if the tumor is near any vital organs.

Both EPP and pleurectomy/decortication are complex surgeries, not performed frequently by most surgeons. They require referral to centers dedicated to such treatments. Many of these centers also specialize in other forms of mesothelioma treatment, either alone or in combination (multi-modal therapy.) You should discuss referrals with your doctor. See also: "The effect of extent of local resection on patients on patterns of disease progression in malignant pleural mesothelioma," by D.J. Stewart, et al in Ann. Thorac Surg., July 2004; 78(1):245-252.