Extrapleural Pneumonectomy

Extrapleural Pneumonectomy (EPP) is an aggressive surgery that may be a treatment option for select pleural mesothelioma patients.

Key Points

  • 1

    Extrapleural Pneumonectomy is considered the most risky and severe curative surgery.

  • 2

    EPP requires removal of the lung, pleural linings of the chest and heart & diaphragm.

  • 3

    EPP can slow the disease progression, alleviate symptoms and improve prognosis.

  • 4

    A recent study found EPP could achieve a median survival about about 38 months.

Mesothelioma is a rare type of cancer that develops in the mesothelium, the lining that surrounds and protects the body’s internal organs. Presently, only two types of potentially “curative” surgeries exist to treat pleural mesothelioma– pleurectomy and extrapleural pneumonectomy. These two surgeries do not always cure mesothelioma, but can remove the bulk of the cancer cells, which in turn helps to control the disease and increase a patient’s life expectancy. Extrapleural pneumonectomy is a more risky, invasive, and severe surgery than pleurectomy, but it also provides great potential for the outcome of the patient.

About Extrapleural Pneumonectomy

Extrapleural pneumonectomy involves the removal of the entire diseased lung, the pleural lining of the chest wall, the diaphragm, and the pleural lining of the heart. Extra pleural pneumonectomy is considered a serious operation, it is often determined as a surgery of last resort. It is only performed on patients who are in the early stages of cancer; that is, before the cancer spreads to the lymph nodes and before it invades surrounding tissues and organs. This allows the bulk of the cancer cells to be surgically removed.

Surgery candidates need to be in relatively good health, with good lung and heart function, because removal of an entire lung will increase the load on both the heart and the remaining lung. Surgery candidates also need to be strong and healthy enough to withstand the demands of major surgery and the healing it will require.

Benefits and Risks

Those considering extrapleural pneumonectomy need to be aware of the surgery’s potential risks and benefits. For those who are viable candidates, this operation is considered the best method of controlling malignant mesothelioma for the longest period of time. It can slow the progression of the disease, increase the patient’s quality of life, and improve the patient’s breathing. Combined with a regimen of radiation treatment and chemotherapy, extrapleural pneumonectomy can increase a patient’s life expectancy by months or years.

These possible benefits, however, need to be weighed against the major risks posed by this surgery. Possible complications include internal bleeding, respiratory failure, pneumonia, infection, blood clotting, and even death. About 6 or 7 out of every one hundred patients who receive extrapleural pneumonectomy die during or immediately following the operation. In some cases, mesothelioma reoccurs even after the surgery is complete.

What is Involved in Surgery?

Due to extrapleural pneumonectomy being such a technically complicated surgery, it is usually performed only in large medical centers by surgeons who are experienced with mesothelioma. Qualified surgeons are found across the country. This means that many patients need to travel to receive this mesothelioma treatment.

Extrapleural pneumonectomy requires general anesthesia. In order to access the patient’s chest cavity, the surgeon opens the chest either at the front, called a sternotomy, or at the side, called a thoracotomy. This creates a wound about 9 inches long. The surgeon then visually inspects the chest cavity for diseased tissue. Any visible cancer is removed, including the entire diseased lung, the pleural lining of the chest and heart, and the diaphragm.

Recovery from the surgery usually requires a two week stay in the hospital, during which a health care team monitors the patient’s recovery and watches for possible complications. Full recovery takes an additional 6 to 8 weeks.

Is an Extrapleural Pneumonectomy for You?

Patients need to remember that this operation does not always cure mesothelioma. The operation must be a part of an overall treatment plan that includes radiation and chemotherapy. Talk to your doctor to determine whether or not this procedure will be helpful for you. A major surgery such as extrapleural pneumonectomy is not the right choice for everyone, but for those patients who are candidates, it can substantially increase both life expectancy and quality of life.

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