Mesothelioma Surgical Recovery

Key Components of Surgical Recovery

Recovery from mesothelioma surgery isn’t just about time. Some aspects of the recovery will occur in different settings: inpatient or outpatient. Other aspects require specific types of therapy to improve body function and retain quality of life.

Inpatient Recovery and Outpatient Recovery

Inpatient recovery occurs with the patient staying overnight at the hospital where they had surgery. Outpatient recovery happens while the patient is living at their residence, either visiting a medical institution for treatment or receiving care at their residence.

Surgery requires inpatient and outpatient recovery. Inpatient recovery is intensive and lasts only one to two weeks, whereas outpatient is longer but less intensive.

Physical Therapy

Physical therapy is essential after mesothelioma surgery. Pleural mesothelioma patients require therapies such as coughing and breathing exercises to regain respiratory and cardiovascular function. Peritoneal patients generally require a diet, rest and exercise routine.

Physical therapy is part of inpatient and outpatient recovery. These exercises often begin during inpatient recovery and continue in outpatient recovery.

Quality of Life After Surgery

The intent of surgery is to remove mesothelioma tumors, avoid complications, and allow patients to return to their pre-cancer health. Completing this requires physical therapy, return of bodily function and full range of movements or activity.

Another suggestion for quality of life is mental health therapy. This can address psychological worries about recurrence or postoperative complications.

What to Expect After Surgery

Being prepared about the surgical recovery process can dispel fears. Although recovery is different for each procedure, all patients will have some shared experiences during the inpatient recovery stage:

Some of these will subside within a few hours after waking up from surgery. Others may last a few days.

When you wake up from surgery, you may also have:

• A tube to drain urine from your bladder, air from your chest and fluid from your chest
• Compression boots, elastic stockings or inflating/deflating sleeves to prevent blood clots and improve circulation in your legs

During outpatient recovery, most people experience some level of fatigue until full recovery. Patients should expect routine check-ins with their doctor in the first couple of months after surgery.

Follow-up appointments will monitor the potential for mesothelioma recurrence. These appointments occur as often as once every three months or as infrequently as once a year.

Extrapleural Pneumonectomy (EPP) Recovery

Extrapleural pneumonectomy is the original surgery for pleural mesothelioma. It removes the affected lung, plus the pleura, diaphragm (muscle between the lungs and abdomen) and pericardium.

Removing the lung makes EPP the most intensive and aggressive surgery for mesothelioma. Likewise, extrapleural pneumonectomy recovery is the most intensive of the operations. The respiratory system must adjust with just one lung going forward. This requires breathing and coughing exercises soon after surgery.

Extrapleural Pneumonectomy Recovery Time

According to the University of California San Francisco Department of Surgery website, inpatient recovery usually takes two weeks. Outpatient recovery takes 6-8 weeks.

The entire process lasts 8-10 weeks, although respiratory function may improve months after the operation.

Extrapleural Pneumonectomy Recovery Steps

After completing EPP, patients remain in the hospital for approximately two weeks. At this time, the medical team monitors the patient’s vitals and starts physical therapy. The patient may remain in the Intensive Care Unit for the first few days. They’ll likely be on a respirator to assist with breathing. They’ll also walk multiple times a day to improve respiratory function.

According to the Baylor St. Luke’s Medical Center Lung Institute, transition from inpatient recovery to outpatient recovery requires:

Once the patient returns home, they continue their walking and breathing exercises. It is important for patients to take their recovery seriously and not overexert themselves.

Pleurectomy With Decortication (P/D) Recovery

The alternative pleural mesothelioma surgery to the EPP is pleurectomy with decortication (P/D). This surgery is less invasive and best when mesothelioma hasn’t spread throughout the nearby lung.

P/D spares both lungs and only removes the pleura, plus part or all of the diaphragm and pericardium.

Pleurectomy With Decortication Recovery Time

P/D involves peeling the visceral (inner) pleura off the lungs, which removes tumors off the lung as well. This step is time-consuming and explains why P/D takes longer than EPP.

However, leaving the lung intact makes the recovery time shorter. Patients should expect 1-2 months of recovery:

• 10-14 days of inpatient recovery
• 2-6 weeks of outpatient recovery

Pleurectomy With Decortication Recovery Steps

Most patients go to the Intensive Care Unit following P/D surgery. A tube helps with breathing, and doctors monitor the lung to ensure it’s inflated.

Breathing, coughing and walking exercises are a staple of P/D inpatient recovery. This can prevent lung infections, increase ventilation and defend against mucus buildup.

Similar to EPP recovery, the Baylor St. Luke’s Medical Center Lung Institute website says transition from inpatient to outpatient care requires:

Outpatient recovery involves the same exercises. It’s likely shorter than the inpatient recovery of EPP, although patients should beware of overexertion.

Cytoreductive Surgery With HIPEC Recovery

Cytoreductive surgery, or cytoreduction, is for peritoneal mesothelioma. It involves “debulking,” or physical removal of visible tumors. Cytoreduction usually requires a peritonectomy, which is resection of the peritoneum (the lining around the abdomen). Doctors may remove affected organs in the abdominal cavity.

Following cytoreduction, patients often receive hyperthermic intraperitoneal chemotherapy (HIPEC). This is a hot liquid chemotherapy that washes the abdomen.

Recovery from the surgery itself is more extensive than EPP or P/D because the abdominal cavity contains 10 primary organs. Tumors may affect any of these organs, requiring resection during surgery.

The remaining organs might have postoperative infections, requiring further medical care and recovery time. Additionally, the patient may experience bowel issues due to the operation’s proximity to the bladder.

Cytoreduction With HIPEC Recovery Time

The dual aspect of cytoreduction with HIPEC requires a lengthy recovery. The Johns Hopkins Medicine website states the recovery time for cytoreduction with HIPEC is 2-3 months:

• 10-14 days of inpatient recovery
• 6-10 weeks of outpatient recovery

Cytoreduction With HIPEC Recovery Steps

Patients may go to the Intensive Care Unit following surgery. They may receive fluids and pain medicine through an IV.

Walking exercises are an important measurement for recovery progression. Regular movement prevents infections and blood clots. Doctors will also monitor bowel movements and intake of food, as the surgery can affect the digestive system.

Patients may remain on an IV during outpatient recovery to supply nutrients to abdominal cavity organs. This also helps the digestive system recover from surgery.

Recovery From Palliative Mesothelioma Surgery

Patients may undergo palliative surgeries for mesothelioma. These operations drain fluid and may remove a small batch of tumors, each of which relieves painful pressure. These operations each require a shorter recovery than EPP, P/D and cytoreduction. 

The main palliative surgeries for mesothelioma are:

• Pleurodesis — Drains fluid from the pleura and closes the pleural space to prevent further fluid buildup
• Thoracentesis — Drains fluid from the pleura to reduce pressure against the chest wall and allow the lungs to expand
• Paracentesis — Drains fluid from the peritoneum to reduce pressure against the abdominal cavity

Outpatient recovery and care can last a couple of weeks. It mostly involves keeping the wound clean. This requires changing bandages, washing the wound with soap and water, and monitoring fluid leakage.

Outpatient care mostly involves cleaning the wound and preventing infection. Fluid leakage may persist for a day or two following surgery.