Extrapleural Pneumonectomy

Extrapleural pneumonectomy is a surgical treatments for malignant pleural mesothelioma (MPM). In an extrapleural pneumonectomy (EPP), the surgeon removes the diseased lung, part of the pericardium, (membrane covering the heart), part of the diaphragm (muscle between the lungs and the abdomen), and part of the parietal pleura (membrane lining the chest).

An extrapleural pneumonectomy is an invasive and complex operation, and performed only on patients with early stage localized disease that has not spread to the lymph nodes or invaded surrounding tissues and organs. Candidates for surgery must be in otherwise good health with adequate heart and lung function since removal of an entire lung will increase the load on the heart and remaining lung.

While this surgery is potentially curative, improving survival and disease control are two main goals. Extrapleural pneumonectomy is sometimes performed in conjunction with radiation and/or chemotherapy, before or after the operation.

Because the extrapleural pneumonectomy is a technically complex operation, it is generally only performed at large medical centers by surgeons with extensive experience in treating mesothelioma.

Description

In an extrapleural pneumonectomy, requires general anesthesia, the surgeon opens the patient's chest cavity, at either the front, a sternotomy, or on the side, a thoracotomy, and makes an incision of approximately nine (9) inches. The surgeon visually inspects the chest cavity, and removes any visible cancer including the entire diseased lung, the pleural lining of the chest and heart, and the diaphragm.

Recovery is extensive often requiring up to a two week hospital stay.  After discharge, an additional 6 to 8 weeks is required for a full recovery.

Risks and Benefits

An extrapleural pneumonectomy, for the suitable candidate, is potentially the most effective method for disease control of malignant mesothelioma. It can slow disease progression, improve quality of life, especially breathing. When combined with radiation and chemotherapy, extrapleural pneumonectomy can have a significant impact on life expectancy.

These potential benefits must, however, be weighed against the significant risks posed by this surgery, including internal bleeding, respiratory failure, pneumonia, infection and blood clots. Approximately 6% of patients undergoing extrapleural pneumonectomy die during or immediately following the procedure, although that perctentage is lower at surgical Centers of Excellence with broad experience in performing the procedure.  Even with the operation, the cancer often recurs at some future time.