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Extrapleural Pneumonectomy (EPP)

This is a very aggressive surgery that involves removing the entire affected lung, the cancerous pleura (lining of the lungs), part of the pericardium and part of the diaphragm.  The idea is to remove all visible signs of cancer and the areas where the cancer most frequently metastasizes to.

Undergoing the Extrapleural Pneumonectomy

It is a difficult surgery to recover from, often taking months for complete recovery.  This is the type of surgery done for pleural mesothelioma.A person undergoing an extrapleural pneumonectomy (EPP) must be physically and emotionally healthy enough to tolerate this aggressive surgery.  For this reason, doctors often do preoperative testing, including pulmonary function tests, stress tests and EKGs to make sure the heart and lungs are healthy enough for surgery.

The EPP is a controversial surgery, with some doctors believing it doesn’t extend the lifespan in many patients who have it even though it is intended to remove all the cancer cells.

The Risks of Extrapleural Pneumonectomy

As this is a serious type of surgery, complications and risks are not uncommon.  Some of these complications include:

  • Respiratory failure
  • Empyema (a buildup of infected fluid within the lungs)
  • Internal bleeding
  • Blood clot or deep vein thrombosis (DVT) in the lower legs which can travel to the lungs
  • Pneumonia
  • Death due to complications of surgery

An EPP must be done by specialty surgeons who have performed the procedure several times. It is done at specialty centers where staff know how to manage the complications of this surgery.

The Surgery Itself

During the surgery, a large incision is made with immediate removal of the sixth rib.  This opens up the surgical space and allows doctors to see where the mesothelioma is.   The doctors then intentionally collapse the lung and clamp off the major blood vessels, nerves and bronchial tube leading to the affected lung.  The pleural lining of the chest cavity is removed, along with the pericardium (which surrounds the heart), and certain portions of the diaphragm.

These areas are patched up with artificial materials.  The doctors inspect the lung cavity for signs of cancer; if they see no more, the incision is closed completely and a drain is placed in the chest wall in order to collect fluid and blood that drain in the first few days of surgery.  The drain is removed when it no longer produces fluid.

Is the EPP for You?

Talk to your mesothelioma specialist to see if this surgery will help you.  Your doctor should be able to predict if the surgery will be helpful to you.  Don’t be afraid to get a second opinion if you are not happy with the information the first doctor gave you.

Sources & Author Edited: September 1, 2015

About the Writer

Retired LCDR Carl Jewett

LCDR Carl Jewett is a retired Naval Officer, having served just under 24 years in the submarine force. He currently serves as a VA Accredited Claims Agent and as the Executive Director of the Veterans Assistance Network. He specializes in assisting veterans filing VA claims for asbestos-related disabilities such as mesothelioma and asbestos-related lung cancer.

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