Surgery for mesothelioma is a major decision, and not everyone is a candidate. Per the NCI and ACS, the two main operations for pleural mesothelioma are pleurectomy/decortication (P/D), which spares the lung, and extrapleural pneumonectomy (EPP), which removes it. Whether surgery is right for you depends on cell type, stage, and overall health, and that call is made with a specialist.
If your doctor has raised the idea of surgery, you are allowed to slow down and ask questions first. A good surgical team will welcome them. Below are the questions worth asking, what recovery can look like, and what to do if surgery is not on the table. Bring this list to your appointment.
Is mesothelioma surgery worth it?
There is no single answer, and anyone who promises you one is overselling. Whether surgery helps depends on your cell type, your stage, your lung and heart function, and your own goals for treatment. For some patients, surgery combined with other treatments can be a central part of the plan. For others, the risks outweigh the benefit. The honest answer comes from a mesothelioma specialist who has reviewed your case, not from a website. What this page can do is help you ask the right questions so the decision is truly yours.
Am I a candidate for surgery, and what is P/D versus EPP?
Not every patient is a surgical candidate. According to the NCI and ACS, candidacy depends on the cell type (epithelioid cases are often better surgical candidates than sarcomatoid), the stage of the cancer, and whether your overall health and lung function can handle a major operation. The two main surgeries for pleural mesothelioma differ a great deal, so it helps to understand them before you talk options with your surgeon.
| Pleurectomy/decortication (P/D) | Extrapleural pneumonectomy (EPP) | |
|---|---|---|
| What is removed | The pleura (lung lining) and visible tumor; the lung is left in place | The affected lung along with the pleura, and often part of the diaphragm and the lining around the heart |
| Sometimes called | Lung-sparing surgery | Lung-removing surgery |
| General idea | Keeps the lung, aims to strip cancer from around it | Removes more tissue by taking the whole lung |
| Combined with | Usually paired with other treatments such as chemotherapy | Usually paired with other treatments such as chemotherapy and sometimes radiation |
Plain description of the two main operations, per NCI/ACS. Which one fits, or whether either does, is a judgment your surgical team makes for your specific case.
The right question is not “which surgery is better” in general. It is “which approach, if any, fits my cell type, stage, and health, and why.” Ask your surgeon to walk you through their reasoning.
What questions should I ask the surgeon?
Write these down and take them with you. You can ask a family member to take notes so you can listen.
- How many mesothelioma surgeries like mine do you and this center perform each year?
- Am I a candidate for P/D, EPP, both, or neither, and what is driving that recommendation?
- What is the goal of this surgery for me specifically?
- How does surgery fit with chemotherapy, immunotherapy, or radiation in my plan?
- What are the most likely complications, and how often do they happen at this center?
- What does recovery look like week by week, and how long until I feel like myself?
- What happens if you open me up and find more cancer than expected?
- Is there a clinical trial I should consider instead of, or alongside, surgery?
- What are my options if I choose not to have surgery?
If you have not already had a specialist review your case, this is the moment for one. See our guide to getting a mesothelioma second opinion.
What is recovery like after mesothelioma surgery?
Recovery from a major chest operation takes time, and it is normal for it to be hard at first. Most patients spend time in the hospital after surgery, then continue healing at home over weeks. You may have a chest tube for a period, need help with daily tasks, and feel short of breath or tired as your body adjusts, especially after EPP, where a lung has been removed. Pain control, breathing exercises, and slowly rebuilding activity are usually part of the plan. Ask your team for a realistic recovery timeline for your operation, and line up help at home before the surgery date so you are not arranging it while you heal.
What are the risks of mesothelioma surgery?
These are big operations, and they carry real risks. The exact risks depend on which surgery you have and your own health, so ask your surgeon for the specifics in your case. In general terms, chest surgery of this kind can involve complications such as infection, bleeding, breathing problems, fluid around the lung or heart, and a longer or harder recovery than expected. EPP removes a whole lung, so it asks more of your body than lung-sparing P/D. None of this means surgery is wrong for you. It means the decision deserves a clear, specific conversation about benefit versus risk, made with a specialist who treats mesothelioma often.
What if I am not a surgical candidate?
If surgery is not an option, that does not mean nothing can be done. Many patients with mesothelioma are treated without surgery, and treatment for this disease almost always combines more than one approach. Per the NCI and ACS, options outside of surgery can include chemotherapy, immunotherapy, radiation, supportive care to manage symptoms, and clinical trials of newer treatments. A specialist can build a plan around your case and your goals. Being told you are not a surgical candidate is a hard moment, and it is also a good reason to get a second opinion so you know every option has been considered. You can read more on our mesothelioma treatment page.
You do not have to figure this out alone. A patient advocate can help you find a mesothelioma specialist near you, gather your records for a surgical consult, and understand what financial help your family may qualify for, at no cost to you.
Call 24/7: 1-800-877-6000 · or check your eligibility in 3 questions.
By Dave Foster, Patient Advocate. MesoCare is a patient-and-family resource sponsored by Danziger & De Llano. This article is for general education and is not medical or legal advice. It does not replace the guidance of your own surgical and oncology team. Always follow the plan your doctors set for your specific case.
Sources
- National Cancer Institute (cancer.gov): malignant mesothelioma treatment, surgery types (pleurectomy/decortication and extrapleural pneumonectomy), and combined treatment.
- American Cancer Society (cancer.org): surgery for malignant mesothelioma and who may be a surgical candidate.
- (Re-verify all source URLs at publish.)