Extrapleural Pneumonectomy (EPP)

Extrapleural pneumonectomy is a major surgery used to treat pleural mesothelioma in which the surgeon removes the entire lung on the affected side along with the lining around the lung (pleura), the lining around the heart (pericardium), and the diaphragm muscle on that side. The pericardium and diaphragm are then reconstructed with surgical patches. It is one of the most extensive cancer operations performed and is offered only to carefully selected patients with early-stage disease and adequate heart and lung function.

Origin

The term combines "extrapleural" (outside the pleura) with "pneumonectomy" (removal of a lung, from Greek pneumon, lung). The procedure was developed in the mid-20th century for tuberculosis and was adapted for mesothelioma by Dr. Eric Butchart in the 1970s and refined for routine oncologic use by Dr. David Sugarbaker at Brigham and Women's Hospital beginning in the 1980s.

Significance in Asbestos Context

EPP has historically been one of the two main surgical options for pleural mesothelioma, alongside the less radical pleurectomy/decortication (P/D). Because the lung itself is removed, recovery is long and the risks (including death, infection, blood clots, heart rhythm problems, and permanent loss of half the breathing capacity) are substantial. Over the past two decades many leading mesothelioma centers have moved toward lung-sparing P/D when feasible, after studies (notably the MARS trial) raised concerns that EPP did not improve survival and reduced quality of life compared with less aggressive approaches. EPP is still performed at some specialized centers for selected patients, usually as part of multimodal treatment combining surgery with chemotherapy and sometimes radiation. Patients considering EPP should seek evaluation at a high-volume mesothelioma center and ask directly whether P/D is an option for their case.

Example Sentence

After her epithelioid mesothelioma was staged as early disease, the thoracic surgeon discussed both extrapleural pneumonectomy and pleurectomy/decortication, explaining the trade-offs between cancer control and long-term breathing function.

Related Terms

Pleurectomy/Decortication (P/D), Pleural Mesothelioma, Multimodal Therapy, MARS Trial, Cytoreductive Surgery, Pleura

Notes

• Ask whether you are a candidate for lung-sparing pleurectomy/decortication (P/D) before agreeing to EPP; many centers now favor P/D for similar survival with less morbidity.
• Seek evaluation at a high-volume mesothelioma program (such as Brigham and Women's, MD Anderson, UCLA, Memorial Sloan Kettering, Penn, or a comparable specialty center). Outcomes are strongly tied to surgical volume.
• Confirm your cell type (epithelioid, biphasic, or sarcomatoid) before surgery, because patients with sarcomatoid mesothelioma generally do not benefit from EPP.
• Request pulmonary function tests, a cardiac stress test or echocardiogram, and a quantitative perfusion scan; surgeons need these to determine whether you can tolerate losing a lung.
• Preserve all operative reports, pathology reports from the resected specimen, and pre-/post-op imaging. These document the extent of disease and treatment and are central evidence in an asbestos claim.
• Ask about clinical trials combining EPP or P/D with immunotherapy or intraoperative chemotherapy, which may be available at specialized centers.