Surgery for pleural



Surgical treatment options for mesothelioma depend on a number of things including the type of mesothelioma, how advanced the disease is, general health and fitness and personal preference. 

There are two approaches to surgery for people with mesothelioma: radical surgery and palliative surgery.


Radical surgery

Unlike radical surgery for other cancers where it can offer the chance of a cure; this is not the case with mesothelioma. Results from a clinical trial called MARS2 suggest that for many, the risks of this type of surgery outweigh the potential benefits.

This is because participants in the trial who underwent surgery had a higher risk of dying when compared with those that did not. The surgery group also had a greater risk of serious side effects and poorer quality of life.

Watch this interview between Mesothelioma UK ambasssador and retired BBC Radio Four Correspondent Carolynn Quinn and John Edwards, Consultant Cardiothoracic Surgeon from Sheffield Teaching Hospitals, to find out more about the trial.


Palliative surgery

The type of operation depends on whether the lung on the affected side will expand or not. If, after drainage of the fluid around the lung (pleural effusion), the lung will expand, then the options are either the insertion of sterile talc around the lung to seal the space between the pleural linings (pleurodesis) or the removal of the bulk of the tumour (pleurectomy). Both these procedures can be performed reliably by keyhole video assisted thoracoscopic surgery (VATS).

If, however, the lung is encased by tumour and cannot expand after fluid has been drained, then surgical removal of the surface layer of the lung (decortication) will be required to make it possible for the lung to expand and thereby improve the function of the lung and improve shortness of breath. It is sometimes possible to decorticate the lung by keyhole surgery (VATS), but the majority of surgeons would perform decortication by opening the chest with a large cut made around the back below the shoulder blades, between the ribs this is called a thoracotomy.

Thoracotomy and decortication is a larger procedure reserved for the younger, fitter patients. In the elderly, more infirm patient, a tunnelled, indwelling pleural catheter (TIPC) can be inserted. This is a permanent drain with a valve that empties the pleural fluid into a vacuum bottle, every few days as required. More information about TIPC can be found in the Managing Symptoms section.


Referral for surgery

Patients can discuss the appropriateness of surgical treatment with the doctor who is currently caring for them. Not all hospitals are able to offer surgical treatment for mesothelioma. Referral to other hospitals for treatment can be done by the hospital team currently caring for the patient or the GP where this is not feasible. Mesothelioma UK can help to identify the nearest surgical unit, where this is requested.

Surgery is frequently used across the UK to gain a diagnosis and treat pleural effusion. The provision of surgery may vary between parts of the UK and different hospitals.


If you would like to speak to a clinical nurse specialist about the above information please call our Freephone Support Line on 0800 169 2409 or email