Mesothelioma Extrapleural Pneumonectomy (EPP)

Malignant mesothelioma affects thousands of people in the U.S. It is a type of cancer that most often comes from exposure to asbestos. Although it is typically terminal, treatments are available to improve a patient’s prognosis and quality of life. If you have malignant mesothelioma, one treatment option may be extrapleural pneumonectomy, or EPP. EPP was the very first surgical treatment developed for mesothelioma of the lining of the lungs. EPP can drastically increase the survival rate of a patient with malignant pleural mesothelioma.

What Is Extrapleural Pneumonectomy?

Extrapleural pneumonectomy is a type of surgery that removes the parts of the body most affected by pleural mesothelioma. These include the lung that contains the cancerous mass as well as surrounding tissues in the pericardium and parietal pleural (the membranes covering the heart and chest, respectively). EPP may also remove part of the diaphragm. It is a complicated operation that is not suitable for every patient with pleural mesothelioma. The recovery time for extrapleural pneumonectomy is about six to eight weeks. It may take longer, however, for the remaining lung to fully adjust.

Are You a Candidate?

Extrapleural pneumonectomy is most appropriate for patients in the earlier stages of pleural mesothelioma (1 and 2). In stages 3 and 4, the cancer may have spread elsewhere throughout the body, making EPP ineffective at improving prognosis. In general, a doctor may recommend EPP in a patient whose mesothelioma has expanded beyond the outer and inner pleura and into the lung, but that has not spread outside of the chest cavity.

Once mesothelioma spreads to the lymph nodes, it is generally too late for extrapleural pneumonectomy to be effective or worth the potential risks. A patient must also be in generally good health with decent lung and heart function to be eligible for this surgical mesothelioma treatment.

What Is the Success Rate for Extrapleural Pneumonectomy?

The two main goals for EPP are to mitigate the disease and improve survival rates, not to cure mesothelioma. EPP has a high success rate in achieving its goals. It can slow down the spread of malignant mesothelioma and help with breathing. Numerous studies of patients who have undergone extrapleural pneumonectomy have found life expectancies of 18 to 24 months and longer.

When combined with chemotherapy, EPP could extend a patient’s life by years. A study by Baylor Scott & White Medical Center in 2017 found that EPP combined with intensity modulated radiation therapy had a median survival rate of 38.2 months. Patients also experience improved qualities of living, such as finding it easier to breathe and carry out day-to-day tasks.

Are There Alternatives for EPP?

Many patients have found great success with extrapleural pneumonectomy in treating malignant mesothelioma and improving their lifespans. However, there are potential risks and drawbacks. The most serious threat is that of death during or shortly after the surgery. The mortality rate for EPP is higher than similar but less radical surgical procedures to treat pleural mesothelioma, such as pleurectomy/decortication (P/D) surgery.

P/D is also an aggressive treatment option. It involves removing visible tumor masses and the pleural lining but leaving the affected lung. Patients who undergo EPP could also face the risk of localized cancer recurrence, although postoperative radiation therapy will diminish this risk.

Talk to Your Doctor About Extrapleural Pneumonectomy

Malignant mesothelioma is an aggressive type of cancer with no known cure. Treatments often need to be aggressive to match for patients to enjoy life-changing results. EPP is an invasive surgery that could add months or years to your life, as well as substantially improve your quality of living. Talk to your doctor to see if extrapleural pneumonectomy is the right treatment option for you. A less aggressive surgery, such as P/D, may be more suitable. Your physician can run special tests to determine if you are a candidate for extrapleural pneumonectomy.