Overview
Extrapleural pneumonectomy (EPP) is a radical surgical procedure that removes the affected lung along with the pleura, diaphragm, and pericardium (the sac around the heart). This aggressive approach aims for complete tumor removal but comes with higher risks and significant lifestyle changes.
Who May Be a Candidate
- Early-stage disease (typically stage 1-2)
- Epithelioid cell type strongly preferred
- Excellent overall health
- Good heart and kidney function
- Adequate lung function to survive with one lung
- No spread to lymph nodes or distant sites
How It Works
The surgeon removes the entire lung on the affected side, along with the surrounding pleura, diaphragm, and pericardium. The diaphragm and pericardium are reconstructed with synthetic patches. The goal is complete macroscopic removal of all tumor.
Procedure Steps
- Thorough pre-surgical evaluation including heart and lung function tests
- General anesthesia with one-lung ventilation
- Extended thoracotomy incision
- Removal of entire lung and pleura
- Removal of diaphragm and pericardium
- Reconstruction with Gore-Tex or similar patches
- Chest closure with drainage tubes
Benefits
- Most complete tumor removal possible
- Lower local recurrence rates
- May improve survival in select patients
- Removes entire potential field of cancer
Risks & Side Effects
- Higher mortality rate (4-10%)
- Major complications in 20-50% of patients
- Permanent loss of lung
- Cardiac arrhythmias
- Respiratory failure
- Patch failure or infection
- Significant lifestyle changes
Recovery
Hospital stay is typically 10-14 days or longer. Full recovery takes 2-3 months. Patients must adapt to living with one lung, which limits exercise capacity. Pulmonary rehabilitation is essential.
Expected Outcomes
Median survival varies from 12-22 months in most studies. When combined with chemotherapy and radiation (trimodality therapy), select patients may live 3-5 years or longer. Careful patient selection is critical for good outcomes.
Finding Treatment
This procedure is typically performed at specialized mesothelioma treatment centers with experienced surgical teams. Consulting with a mesothelioma specialist is the first step in determining if this treatment is appropriate for your situation.