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Surgery for mesothelioma: what it can and cannot do | CION Cancer Clinics
For most people with pleural mesothelioma, surgery is used to confirm the diagnosis and to stop fluid building up around the lung, so breathing is easier. A major operation to remove the lining of the lung, or the whole lung, is possible only for a small group of very fit people with early disease. This page explains each option, who it does not suit and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What can surgery actually do for mesothelioma?
- Which operations are used, and what is each one for?
- How does the team work out what is possible for you?
- What do families often assume about this surgery?
- What do the words on the report mean?
- How strong is the evidence for the bigger operations?
- How do the smaller and larger procedures compare?
- Common questions about surgery for mesothelioma
The short answer
What can surgery actually do for mesothelioma?
For most people with pleural mesothelioma, surgery is used to confirm the diagnosis and to control fluid and breathlessness, not to remove the cancer. A large operation to take away the lining of the lung is possible for a small group of people, and even then it is debated.
What mesothelioma is, in a sentence
Pleural mesothelioma is a cancer of the pleura, the thin double lining that wraps the lung and lines the inside of the chest wall. It is usually linked to breathing in asbestos dust, often many years before. It tends to spread as a sheet across the lining rather than as one lump, which is why a surgeon cannot simply cut it out.
Three goals, very different operations
When a surgeon talks about operating, ask which goal they mean. The first is getting tissue for a firm diagnosis. The second is stopping fluid from building up again around the lung. The third is removing as much visible cancer as possible. The first two are small procedures that many people can have. The third is a major chest operation that only a few people are fit enough for.
This page explains the options. It cannot tell you which one suits you. That depends on your scans, your biopsy and your fitness, which only your treating team has in front of them.The options
Which operations are used, and what is each one for?
They range from a keyhole procedure with a short stay to one of the largest operations in chest surgery.
Keyhole biopsy
Through one or two small cuts in the side of the chest, the surgeon looks at the lining with a camera and takes samples. Fluid is drained at the same time.
Often called
- VATS, or thoracoscopy
- Pleural biopsy
Stopping the fluid
Talc can be put into the chest to make the two layers of lining stick together, so fluid has nowhere to collect. Or a thin tube is left in place so the fluid can be drained at home.
Often called
- Pleurodesis
- Indwelling pleural catheter
Removing the lining
Through a larger cut between the ribs, the surgeon peels the diseased lining off the lung and the chest wall. The lung itself stays. Sometimes part of the breathing muscle is removed and patched.
Known as pleurectomy and decortication.Removing the whole lung
The lining, the entire lung on that side, part of the breathing muscle and part of the sac around the heart are removed together. It is done far less often than it once was.
Known as extrapleural pneumonectomy, or EPP.Not sure whether this applies to you?
Ask an oncologistThe pathway
How does the team work out what is possible for you?
-
A firm diagnosis and the cell type
The biopsy report names the type of mesothelioma cell. Epithelioid, sarcomatoid and mixed types behave differently, and this one line on the report shapes almost everything that follows.
-
Scans to see how far it has spread
A CT scan, and often a PET-CT, shows whether the cancer is on one side only, whether lymph nodes are involved and whether it has grown into the chest wall or beyond.
-
Tests of heart and lung fitness
Breathing tests, a heart check and a walking test show whether your body could cope with a major chest operation and the recovery after it.
-
Discussion at a tumour board
Surgeons, medical and radiation oncologists and radiologists review everything together. For many people the main treatment advised is chemotherapy or immunotherapy, with surgery used for symptoms.
-
A conversation with you and your family
The team explains what they recommend, what else was considered and what each path would mean for daily life. You are free to ask for a second opinion.
Commonly believed
What do families often assume about this surgery?
"If they will not operate, nothing can be done."
Most people with mesothelioma are not offered a major operation, and that is usual rather than a sign of giving up. Treatment with medicines, radiotherapy for pain, and procedures to control fluid can all make a real difference to how you feel.
"A bigger operation must mean better results."
Not necessarily. Larger operations carry more risk and a longer recovery, and trials have not shown that they help everyone who has them. The right size of operation is the one that fits the disease and the person.
"Draining the fluid will make the cancer spread."
Draining fluid is done to help you breathe. It does not cause the cancer to spread through the body. Rarely, mesothelioma can grow along the track of a needle or tube, and your team watches for this.
"We should wait until he is weaker before deciding."
Fitness is one of the main things the team weighs. Some options are only open while a person is strong enough. Asking early keeps more choices on the table.
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On your report
What do the words on the report mean?
- Pleural effusion
- Fluid that has collected between the two layers of lining around the lung. It is the usual cause of breathlessness in mesothelioma.
- Epithelioid
- The most common cell type. It is the type most often considered for a larger operation.
- Sarcomatoid
- A less common cell type that tends to grow faster. Major surgery is rarely advised for it.
- Cytoreductive surgery
- An operation to remove as much visible cancer as possible, knowing that tiny amounts may remain.
- Palliative
- Treatment aimed at easing symptoms such as breathlessness or pain, rather than removing the cancer.
Being straight with you
How strong is the evidence for the bigger operations?
Honestly, it is uncertain. Large trials in the UK have compared major surgery with treatment without it, and they did not show a clear benefit for the operation. Some specialist centres still offer surgery to carefully chosen people, often as part of a plan with chemotherapy or radiotherapy.
Why doctors disagree
The people who have these operations are usually younger, fitter and have less disease. That makes it hard to know how much of their outcome is due to the surgery and how much to who they were beforehand. Trials are the fairest way to answer that, and so far they urge caution.
What to ask if surgery is suggested
Ask what the operation aims to achieve for you. Ask how often the team does this particular operation, what the main risks are, how long the recovery takes and what the alternative plan would be without it. Ask whether it would be done as part of a study. A good team welcomes these questions.
No one can tell you from this page whether surgery is right for you. That decision belongs with your treating team and with you.Side by side
How do the smaller and larger procedures compare?
Biopsy, talc or a home drain
Removing the lining or the lung
Aim is diagnosis or easier breathing
Aim is removing as much visible cancer as possible
Suitable for most people, including the frail
Suitable only for a small, very fit group
Short hospital stay, sometimes a day case
Intensive care first, then a long hospital stay
Recovery is usually quick
Recovery takes months, not weeks
Questions we are asked
Common questions about surgery for mesothelioma
Can mesothelioma be removed completely with surgery?
Mesothelioma spreads as a thin layer across the lining of the chest, so even the largest operation usually leaves tiny amounts behind. That is why surgery is described as removing all visible cancer, and why it is almost always combined with other treatment. Ask your surgeon to explain what they expect to leave.
Why did the doctor say my father is not suitable for surgery?
Usually for one of three reasons: the cell type on the biopsy, how far the cancer has spread on the scans, or whether his heart and lungs could cope. Being told surgery is not suitable does not mean treatment has ended. Ask the team what they recommend instead and why.
Is the talc procedure a type of cancer surgery?
It is a procedure to stop fluid coming back, not to remove the cancer. Talc is placed between the two layers of lining so they stick together. It can be done during a keyhole operation or through a chest drain on the ward. Its purpose is easier breathing.
Is treatment with medicines used instead of surgery?
For many people, yes. Chemotherapy or immunotherapy is often the main treatment for mesothelioma, and it can be given whether or not an operation is done. Radiotherapy may be used to ease pain in a particular area. Your oncologist will explain which of these suits your situation.
Will we need to travel far for a major operation?
Major operations for mesothelioma are uncommon and are usually done in a few specialist chest surgery centres. Biopsies, talc and home drains are much more widely available. Ask your team where the recommended procedure would be done and how follow-up would work closer to home.
What are the main risks of a large chest operation?
They include bleeding, chest infection, air leaking from the lung, an irregular heartbeat and a slow return of strength. Removing a whole lung carries more risk than removing the lining alone. Your surgeon should explain the risks for your own case and what is done to reduce them.
Does asbestos exposure change what can be done?
It does not change the medical options. It is still worth telling the team about any past work with asbestos, such as in construction, shipyards, brake repair or cement sheet factories. It helps confirm the history, and some families later look into compensation or support.
Can we get a second opinion before deciding?
Yes, and it is common with a rare cancer like this. Bring the biopsy report, the actual scan images on a disc or link, and the breathing test results. A second team can then look at the same information rather than starting again. Asking for one will not offend a good surgeon.
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Dr. C. Raghavendra Reddy
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Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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Radiation Oncologist
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Hematologist
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Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- NHS — Mesothelioma: treatment
- National Cancer Institute — Malignant Mesothelioma Treatment (PDQ), patient version
- Cancer Research UK — Mesothelioma
- American Cancer Society — Malignant Mesothelioma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Who Is a Candidate for Mesothelioma SurgeryWhat the team weighs before offering a major operationPleurectomy and Decortication ExplainedThe operation that removes the lining and keeps the lungPleurodesis for Recurrent FluidHow talc stops fluid returning around the lungDeciding on Cancer SurgeryQuestions to ask before agreeing to an operation
Talk to us
Been told surgery is or is not an option?
Send us the biopsy report and scans, or call the helpline. A surgical oncologist will explain what the options mean for you. One helpline serves every CION centre.