Extrapleural pneumonectomy, also known as EPP, is a radical surgery meant for patients with early stages of mesothelioma. While being a lot more dangerous than other procedures, EPP can help control tumor growth by removing a cancerous lung as well as the surrounding tissues (chest lining, heart lining, diaphragm, and lymph nodes).
EPP is performed on patients who suffer from early stages of pleural mesothelioma when cancer hasn't started spreading yet and is still confined within the chest area. Mesothelioma is not often diagnosed until it reaches more advanced stages, causing many patients not to be eligible for this surgery.
This surgery gets rid of most cancerous tissues by removing the affected lung, thus increasing the lifespan of a patient suffering from mesothelioma. A combination of chemotherapy and radiation treatment can further improve a mesothelioma patient's life expectancy by months or even years.
While mesothelioma, unfortunately, doesn't have a curative operatory procedure, EPP has its uses and can help a select number of patients by controlling asbestos-related cancer they suffer from. The surgery slows the development of cancer and helps with breathing, significantly improving the patient's quality of life. Furthermore, by performing radiation therapy in high doses, cancer can even be prevented from returning locally.
Although beneficial if successful, EPP has a severe risk of death during or shortly after the procedure. The mortality rate of EPP is much higher compared to a less radical procedure that doesn't involve the removal of a lung, called pleurectomy/decortication, or P/D.
Statistically, EPP has higher postoperative mortality (death within 30 days) rate compared to the less radical P/D surgery. EPP also has a higher complication rate and cancer recurrence is another danger for patients who undergo this surgery. Although less common in patients who do radiation therapy after the surgery, cancer recurrence at distant sites still occurs in more than half of patients.
Extrapleural pneumonectomy also involves a few short-term risks, including:
Long-term risks usually involve shortness of breath. This problem can cause patients to be dependent on oxygen tanks or mechanical respirators for months or even years after the surgery.
Other postoperative risks of EPP include chest pain, fever, coughing and shortness of breath. Incisions that become red, swollen or painful are other signs of immediate dangers that must be reported as early as possible.
EPP started in the 1940s as a procedure to treat tuberculosis. The surgery used to result in a high mortality rate during the first years of its use. Several medical improvements have increased the survival rate of EPP.
Before the surgery, doctors take a few precautions to make sure the patients are eligible. Tests are performed to make sure the remaining lung is healthy enough to function on its own. Furthermore, the heart is tested to make sure the patient is healthy enough to undergo major surgery.
Other tests are made to ensure that cancer has not spread to other parts of the body, using bone scans and CT scans.
Extrapleural pneumonectomy is performed under the effects of general anesthesia. Surgeons make an incision, approximately 10 inches long in the front of the body or on the side. Once the incision is made and the internal organs are exposed, doctors will inspect for cancerous tissues and remove as much as possible. This includes the entire cancerous lung and parts of the heart lining, lung lining, diaphragm, and nearby lymph nodes.
Recovering from an extrapleural pneumonectomy is a slow process. Respirators are used during the first days to help patients breath, and drainage tubes must be used to minimize the accumulation of fluid. Patients must stay in the hospital for at least two weeks after the procedure and are monitored closely since complications can appear after this procedure.
Total recovery can last up to eight weeks, but it often takes longer than that. Patients are advised to not push themselves in the months following the procedure so that the remaining lung has time to adapt and take over respiratory functions on its own.
An extrapleural pneumonectomy is a surgical procedure that removes a lung and all surrounding tissues. It was first developed as a way to treat tuberculosis, but it has since been improved and adapted to fit other needs.
Extrapleural pneumonectomy can help patients live longer with pleural mesothelioma, and help with symptom management.
For the first few days after surgery, patients breathe using respirators and require the use of drainage tubes. Total recovery can last more than three months.