What is the difference between P/D and EPP surgery?

Pleurectomy/decortication (P/D) removes the diseased pleural lining and visible tumor while sparing the lung. Extrapleural pneumonectomy (EPP) removes the entire affected lung along with the pleura, diaphragm, and the sac around the heart. P/D preserves lung function and carries a lower mortality risk (about 1-4% versus 4-10% for EPP), which is why many high-volume centers now favor it for eligible patients. The right operation depends on the stage, cell type, tumor location, and the patient’s overall health.

Which mesothelioma procedures only relieve symptoms?

Pleurodesis, thoracentesis, and paracentesis are symptom-relief (palliative) procedures. They don't remove the cancer. Thoracentesis drains fluid from around the lungs and paracentesis drains fluid from the abdomen, both easing pressure and breathlessness. Pleurodesis creates adhesion between the lung and chest wall to stop fluid from building back up. Doctors can do these procedures at any disease stage to improve comfort and quality of life.

Are targeted therapy and photodynamic therapy standard treatments?

Not yet as standard care for most patients. Targeted therapy uses drugs aimed at specific molecular changes in mesothelioma cells and has several options still in clinical development. Photodynamic therapy uses light-activated drugs to kill cancer cells and is being studied as an addition to surgery. Both are available mainly through clinical trials rather than routine treatment, so ask a specialized center whether you qualify for a trial.

Mesothelioma Treatment Procedures

A plain-language guide to the procedures used to treat mesothelioma: surgery that removes tumor, procedures that relieve symptoms, and emerging therapies under study.

Mesothelioma treatment often combines several procedures. Some surgeries aim to remove tumor, others drain fluid to ease symptoms, and newer therapies are still being studied. Each procedure below explains who it helps, how it works, and what recovery looks like. It also covers the outcomes reported in the medical literature.

8 Procedures explained

3 Treatment goals

Reviewed By our editorial board

Surgical Procedures

Surgery aims to remove as much tumor as possible. It's an option for earlier-stage patients in good enough health to recover from a major operation.

Surgery

Pleurectomy/Decortication (P/D)

A lung-sparing surgery that removes the diseased pleural lining while preserving the lung, offering improved quality of life with lower surgical risk.

Learn more → Surgery

Extrapleural Pneumonectomy (EPP)

The most extensive mesothelioma surgery, removing the affected lung, pleura, diaphragm, and pericardium to achieve complete tumor removal.

Learn more → Surgery

Cytoreductive Surgery

A debulking surgery primarily used for peritoneal mesothelioma, removing visible tumors from the abdominal cavity, often combined with HIPEC.

Learn more →

Symptom-Relief Procedures

These procedures don't remove the cancer. They drain fluid and ease symptoms like breathlessness and abdominal pressure, and they can be done at any stage.

Palliative Procedure

Pleurodesis

A procedure to prevent recurrent fluid buildup around the lungs by creating adhesion between the lung and chest wall.

Learn more → Palliative Procedure

Thoracentesis

A procedure to remove fluid from around the lungs, providing immediate relief from breathlessness and discomfort.

Learn more → Palliative Procedure

Paracentesis

A procedure to remove fluid from the abdominal cavity, relieving pressure and discomfort in peritoneal mesothelioma patients.

Learn more →

Systemic and Emerging Treatments

These treatments act on cancer cells through the bloodstream or through newer, still-investigational approaches. Many are available mainly through clinical trials.

Systemic Treatment

Targeted Therapy

Drugs that target specific molecular abnormalities in mesothelioma cells, with several promising options in clinical development.

Learn more → Experimental Treatment

Photodynamic Therapy

An experimental treatment using light-activated drugs to kill cancer cells, being studied as an addition to surgery.

Learn more →

Choosing the Right Procedure

No single procedure fits every patient. The best choice depends on the type of mesothelioma (pleural or peritoneal), the stage, the cell type, and your overall health. Most patients receive a combination of treatments, and the plan is set by a multidisciplinary team at a center that treats mesothelioma regularly.

For the full picture of how these procedures fit alongside chemotherapy, immunotherapy, radiation, and clinical trials, see our mesothelioma treatment overview.