Surgical procedures
There are two main surgical procedures used in the treatment of malignant mesothelioma, pleurectomy and extrapleural pneumonectomy. These procedures are both major operations requiring prolonged anesthesia. Therefore, if a person is being considered for surgery, they will require certain tests to determine their ability to withstand the actual surgical procedure and anesthesia, the recovery period, and the consequences of surgery (which may include the removal of a lung). These include assessments of heart and lung function, overall health and nutritional status.

There are three main indications for surgery:

To take biopsy specimens to confirm a diagnosis, if other invasive techniques have failed.
In early disease, to attempt a cure by cutting out all diseased areas.
If a cure is not likely, to provide palliative therapy (by fusing the two layers of the pleura together, to prevent recurrence of a pleural effusion).
Only 20-30% of patients with malignant mesothelioma prove to be suitable candidates for a surgical procedure. Anyone with distant metastases, certain heart problems (such as a recent heart attack, irregular heart rhythms, or poor function) and poor lung capacity should not be considered for surgery. CT and MRI scans have been used to help define which tumors are likely to be successfully removed by an operative procedure, but this can often only be discovered during the surgery itself.

Because the surgical procedures for malignant mesothelioma are major operations, there is a long recovery time afterwards. Patients usually have pain, breathlessness, weakness and fatigue for weeks or even months later.

Pleurectomy
Extrapleural pneumonectomy