Written By: Devin Golden
Survival Rates and Mesothelioma Surgery
Surgery for mesothelioma has led to longer survival in many patients and complete remission in some cases. Evidence of longer survival is linked to improved outcomes, offering for patients and families a reason for hope. This page explores how surgery can improve the mesothelioma prognosis for patients.
Medically Reviewed By
Dr. Stephen Williams
Precision Oncology Scientist
Medically Reviewed By
Dr. Stephen Williams
Precision Oncology Scientist
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Does Surgery Improve Mesothelioma Survival Rates?
For some patients with mesothelioma, surgery plays an important role in improving survival and quality of life. Research shows that people who undergo surgical tumor removal often live longer than people who do not have surgery, particularly when the disease is diagnosed at an earlier stage and managed by an experienced mesothelioma medical team.
Survival rates for mesothelioma reflect the percentage of patients who reach certain milestones such as 1, 2, 5, or 10 years after diagnosis. Across multiple studies, these benchmarks are higher for patients who receive surgery compared to without surgery.
Why Does Surgery Improve Mesothelioma Survival?
Mesothelioma is an aggressive cancer that tends to spread quickly along tissue surfaces. Treatments such as chemotherapy, immunotherapy, and radiation are valuable tools, but they typically work gradually and may not reduce tumor burden fast enough.
Surgery for mesothelioma, when appropriate, allows doctors to remove as much disease as possible in a single procedure. By significantly reducing the amount of cancer in the body, surgery can:
- Lower the burden placed on vital organs
- Improve the effectiveness of follow-up therapy like chemotherapy, immunotherapy or radiation
- Reduce the likelihood of rapid disease progression or early recurrence
Clinical research supports a multimodal approach, meaning surgery combined with therapies like chemotherapy or immunotherapy, often leads to better outcomes than surgery alone.
Types of Mesothelioma Requiring Surgery
Mesothelioma is categorized based on the location of the affected tissue:
- Pleural mesothelioma develops in the pleura, the thin lining surrounding the lungs. This is the most common form of the disease.
- Peritoneal mesothelioma forms in the peritoneum, the lining of the abdominal cavity.
Studies suggest mesothelioma patients may experience improved survival when surgery is performed by experienced specialists and combined with treatments such as chemotherapy or immunotherapy.
A Rare Form: Pericardial Mesothelioma
A third, much rarer type called pericardial mesothelioma starts in the thin tissue lining around the heart. This form accounts for only about 1% of all mesothelioma cases and is often difficult to diagnose early. This is due to the vague and nonspecific symptoms of pericardial mesothelioma – such as chest pain, shortness of breath, fatigue and palpitations – resembling other common heart conditions.
In select cases, patients may have a pericardiectomy, which is a surgical procedure that removes part or all of the affected heart lining. However, because pericardial mesothelioma is frequently diagnosed at an advanced stage, many patients are not candidates for this surgery. As a result, the average survival for pericardial mesothelioma is poor.
Extrapleural Pneumonectomy
Extrapleural pneumonectomy (EPP) is an aggressive surgery for pleural mesothelioma – and only used in select cases. The goal of EPP is to remove as much of the cancer and diseased tissue as possible while the cancer is still confined to only one side of the chest.
During surgery, doctors remove the entire affected lung, the pleural lining and, in some cases, portions of the diaphragm and the lining around the heart. While this surgery may seem quite extensive, it offers some patients the best opportunity for longer survival.
What Research Shows About Survival After EPP
The average survival time for all pleural mesothelioma cases is 12-18 months. However, studies suggest patients who undergo EPP may experience longer survival compared with those who do not receive surgery:
- In one study of 183 patients who underwent EPP, the median survival was 19 months.
- Another study reported a 2-year survival rate of 41% among patients who received EPP as part of their treatment plan. This means at least 41% of patients lived for at least 2 years following EPP surgery, and some of them for much longer.
Pleurectomy/Decortication
Pleurectomy/decortication (P/D) is a lung-sparing surgery for pleural mesothelioma. Unlike EPP surgery, P/D preserves the integrity of the affected lung while still providing an aggressive treatment option.
The goal of pleurectomy/decortication is to remove all visible tumors. To achieve a comprehensive removal, experienced surgeons take out the pleural lining, where mesothelioma begins, and carefully peel tumors and diseased tissue off of the surface of the lung and chest wall.
Studies show the importance of careful patient selection and a focus on balancing tumor removal with the patient’s ability to tolerate surgery. In one study, the 30-day mortality rate was 4% after P/D and the 90-day mortality rate was 9%, which are both high.
However, another study prioritized patient selection and the expertise of mesothelioma specialists. In that study, the 30-day mortality rate was 0% and the 90-day mortality rate was just 4%, which are both low.
Due to the complexity of the procedure, it is recommended that it be performed by an experienced mesothelioma specialist.
Extended Pleurectomy/Decortication
In some cases, surgeons recommend a more extensive version of P/D – known as extended pleurectomy/decortication. During the extended P/D surgery doctors remove the pleural lining, part or all of the diaphragm and the lining around the heart (the pericardium).
Many mesothelioma specialists favor this approach because it addresses not only the main area of tumors but also the tiny tumor nodules that tend to be scattered along tissue surfaces. Removing these microscopic areas of disease can reduce the risk of recurrence and improve long-term outcomes for carefully selected patients.
What Studies Show About Survival With P/D
Multiple studies classify pleurectomy/decortication as an effective surgery option for pleural mesothelioma:
- Median survival after P/D ranges from 20-32 months.
- 2-year survival rates are reported at approximately 60%. This means more than half of patients live for at least 2 years following P/D surgery.
- 5-year survival rates are around 20%, which is notable for an aggressive cancer like mesothelioma. According to the American Cancer Society, the overall 5-year survival rate for mesothelioma across all cases is around 12%.
Cytoreduction/HIPEC
Cytoreduction combined with HIPEC (heated intraperitoneal chemotherapy) is a surgery for peritoneal mesothelioma, which forms in the lining of the abdominal cavity. For many patients, this surgery has led to significant long-term survival.
Cytoreduction, often described as “debulking,” involves removing visible tumors and diseased tissue throughout the abdomen. Because peritoneal mesothelioma presents as scattered tumors rather than one single mass, the goal of cytoreductive surgery is to remove as much visible disease as possible.
During cytoreductive surgery, surgeons often remove the peritoneal lining, where mesothelioma begins. They also remove other affected but non-essential structures such as the omentum, spleen, and portions of small and large intestines. Mesothelioma specialists determine what to remove on a case-by-case basis, depending on where the cancer is located and how extensively it has spread.
Immediately following the cytoreduction phase of the surgery, surgeons deliver a heated chemotherapy solution directly into the abdominal cavity. This process is called HIPEC.
The chemotherapy circulates within the abdominal cavity. Doctors drain the chemotherapy before closing the incision and ending the operation.
By heating the chemotherapy, doctors enhance the drug’s ability to penetrate and kill microscopic cancer cells that may remain after surgery. Delivering the chemotherapy directly into the abdominal cavity instead of through the bloodstream, it targets the affected area more precisely and limits the impact on healthy cells in the rest of the body.
What Research Shows About Survival With Cytoreduction and HIPEC
Cytoreductive surgery with HIPEC can extend life expectancy for mesothelioma patients compared to chemotherapy alone.
Data from the National Cancer Database includes records from more than 700 patients with peritoneal mesothelioma treated using cytoreduction and HIPEC:
- The average survival was 38 months (more than 3 years).
- The 2-year survival rate was approximately 70%.
How does this compare to all cases of peritoneal mesothelioma?
- The average survival for peritoneal mesothelioma is 18-24 months.
- The typical 2-year survival rate for peritoneal mesothelioma is approximately 35%.
What Is EPIC?
Early postoperative intraperitoneal chemotherapy (EPIC) is similar to HIPEC but delivered into the abdominal cavity at room temperature. EPIC is also administered over several days following cytoreductive surgery instead of the same day.
The medical team leaves catheters in the patient’s abdomen after surgery to allow for administration of a chemotherapy solution. This can kill remaining microscopic cancer cells and improve the effectiveness of the surgery.
In one study, combining cytoreductive surgery, HIPEC, and EPIC, led to a 5-year survival rate of 75%. This is one of the most impressive results in any mesothelioma study to date.
Who Is Eligible for Mesothelioma Surgery?
Surgery is an aggressive treatment for mesothelioma. Physicians carefully evaluate whether the benefits of surgery outweigh the risks, and it is often reserved for patients diagnosed in the earlier stages of mesothelioma.
An advanced stage does not automatically rule out surgery. Eligibility depends on how far the cancer has spread and the patient’s overall health. In some cases, mesothelioma clinical trials use surgery. Treatment decisions must remain individualized and based on specific health factors, the patient’s goals, and their preferences.
Why Mesothelioma Surgery Is Often Combined With Other Treatments
Research shows surgery for mesothelioma is most effective when used as part of a multimodal treatment approach: combining surgery with other therapies such as chemotherapy, immunotherapy, and radiation.
By reducing the amount of active cancer in the body, doctors are more effective at eliminating remaining cancer cells with chemotherapy or immunotherapy. In some cases, doctors give patients chemotherapy or immunotherapy before surgery to shrink tumors and stabilize the disease making surgical removal easier.
Surviving Mesothelioma
Making the decision to have surgery can be hard, and there are risks involved with any major operation. However, many patients have undergone one of these procedures and experienced an improved quality of life, increased survival time and in many cases, long term survival.
Almost every survivor of mesothelioma attributes their success to one of these surgical procedures combined with another treatment. These patients have taken their lives back, by taking every opportunity that came their way to fight their cancer. Learn the steps they took to reach remission in our free Mesothelioma Survival Guide.
Frequently Asked Questions About Survival Rates and Surgery
Why does mesothelioma surgery improve survival rates?
Survival rates improve with mesothelioma surgery due to the nature of removing visible tumors and disease during surgery. Each of the surgeries for mesothelioma takes out the diseased tissue and reduces the danger posed to nearby organs. This can improve the efficacy of systemic treatments and their life expectancy.
What is the survival rate for pleurectomy/decortication surgery?
The reported survival rate for pleurectomy/decortication surgery depends on the amount of time measured and the study. For instance, in one study, the 2-year survival rate for this surgery is around 60%, and the 5-year survival rate is around 20%. This surgery is used for pleural mesothelioma.
What is the survival rate for extrapleural pneumonectomy surgery?
The reported survival rate for extrapleural pneumonectomy surgery depends on the amount of time measured and the study. For instance, in one study, extrapleural pneumonectomy had a 2-year survival rate of 41%. This surgery is used for pleural mesothelioma.
What is the survival rate for cytoreductive surgery?
The survival rate for cytoreductive surgery can be high thanks to the inclusion of heated intraperitoneal chemotherapy (HIPEC). The 2-year survival rate for cytoreduction with HIPEC is approximately 70%, which is much higher than the 2-year survival rate for all patients with peritoneal mesothelioma (35%).
Sources & Author
- Disaster on MARS2? Lessons Learned from Modern Day Outcomes of Surgery for Pleural Mesothelioma. Annals of Thoracic Surgery. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/41638523/. Accessed: 02/18/2026.
- Extrapleural pneumonectomy (EPP) vs. pleurectomy decortication (P/D). Annals of Translational Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497106/. Accessed: 12/07/2020.
- Pleurectomy Decortication in the Treatment of Malignant Pleural Mesothelioma. Annals of Surgery. Retrieved from: https://journals.lww.com/annalsofsurgery/abstract/2022/06000/pleurectomy_decortication_in_the_treatment_of.27.aspx. Accessed: 12/07/2020.
- Pleurectomy/decortication and hyperthermic intrathoracic chemoperfusion using cisplatin and doxorubicin for malignant pleural mesothelioma. Journal of Thoracic Disease. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/31285889/. Accessed: 07/18/19.
- Extrapleural Pneumonectomy versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma. Annals of Surgical Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/33971174/. Accessed: 05/21/2021.
- Survival Rates for Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/survival-statistics.html. Accessed: 11/03/2022.
- Surgical indications for pleurectomy decortication in pleural mesothelioma based on the newly revised 9th edition tumor-node-metastasis classification. Interdisciplinary Cardiovascular and Thoracic Surgery. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/39731746/. Accessed: 01/05/2025.
AI Summary of Survival Rates and Mesothelioma Surgery
This page provides an overview of how surgery can positively affect survival rates for individuals diagnosed with mesothelioma, a rare and aggressive cancer often linked to asbestos exposure. Surgery has been shown to improve the chances of survival by removing visible tumors and diseased tissue, which is particularly important because mesothelioma tends to spread rapidly and difficult to control with other treatments alone. For many patients, surgery combined with other therapies can lead to longer life expectancy and better quality of life, giving hope to those facing this challenging diagnosis.
There are different types of surgical procedures used to treat mesothelioma, primarily depending on whether the cancer affects the lining around the lungs or the abdominal cavity. For pleural mesothelioma, which develops in the lining around the lungs, surgeries such as extrapleural pneumonectomy and pleurectomy/decortication are common choices. Extrapleural pneumonectomy involves removing the lung along with the lining, while pleurectomy/decortication aims to remove the lining and tumors without removing the lung itself. These surgeries have different survival statistics, but both show promising results when combined with other treatments like chemotherapy. For peritoneal mesothelioma, which occurs in the abdominal lining, cytoreduction surgery paired with heated chemotherapy known as HIPEC can substantially extend survival rates.
Patient selection for surgery typically depends on factors like the stage of the disease and overall health. Surgery is most effective when performed on earlier-stage mesothelioma (stage 1 or 2), and it is usually combined with other therapies to maximize survival chances. The decision to proceed with surgery involves careful evaluation by medical specialists, weighing the potential benefits against the risks involved with major surgery. Many patients who have surgery and follow-up treatments report increased survival times, and some have even reached remission. Although the journey is difficult, advancements in surgical techniques and multimodal treatment approaches continue to improve outcomes, offering hope and a better outlook for patients and their families.