Extrapleural Pneumonectomy Surgery (EPP)

Extrapleural Pneumonectomy Surgery (EPP) for Mesothelioma

Extrapleural Pneumonectomy (EPP) is a significant surgical intervention used in the treatment of pleural mesothelioma. This procedure entails the removal of the lung affected by cancer, along with the lung’s lining, the heart’s lining, and parts or all of the diaphragm. EPP typically forms part of a broader treatment approach that may include chemotherapy and radiation therapy.

EPP’s Role in Mesothelioma Treatment

EPP’s primary aim is to remove visible cancerous tissues to improve the prognosis by minimizing tumor cells in the body. Generally part of a multimodal therapy plan, EPP is often combined with other treatments like chemotherapy and radiation, either before or after surgery, to maximize its effectiveness and address any remaining cancer cells. According to the National Library of Medicine, a study was conducted to quantify and assess factors influencing 30- and 90-day mortality rates across extrapleural pneumonectomy (EPP), pleurectomy/decortication (P/D), and nonoperative approaches. The 30-day mortality rates were at 3.0% for EPP and 5.4% for P/D. These findings should be taken into account when advising potentially eligible patients about the advantages and drawbacks of undergoing resection.

The Extrapleural Pneumonectomy Surgical Procedure

Performed in specialized mesothelioma centers, EPP follows these general steps under general anesthesia:

  1. Administration of general anesthesia to the patient.
  2. A thoracotomy incision to access the chest cavity, possibly involving rib removal for better access.
  3. Excision of the affected lung, the surrounding linings, and any cancerous diaphragm parts.
  4. Lymph node removal from the chest area involved.
  5. Surgical repair of the diaphragm and pericardium using specialized materials.

Patients typically remain in the hospital for 1 to 2 weeks post-surgery for monitoring and care.

Recovery Process Following EPP

The recovery from EPP involves two main phases:

  1. In-hospital Recovery: Lasting approximately two weeks post-surgery.
  2. Home Recovery: Extending from hospital discharge, usually lasting between 1.5 to 3 months.

During recovery, patients might experience changes in physical stamina, some discomfort in the operated area, and a need for gradual resumption of activities. Following medical advice, engaging in physical therapy, and consistent breathing exercises are key to a successful recovery.

Prognosis and Survival After Extrapleural Pneumonectomy

The prognosis following EPP varies, with survival ranging from 11 to 51 months. Factors influencing this include the patient’s overall health, tumor type, and the specifics of the treatment regimen. The integration of EPP with other therapies typically yields a more favorable survival rate than EPP alone.

Benefits and Challenges of EPP

EPP can potentially improve life quality, especially for those with tumors that have invaded the lung. The surgery may offer a higher chance of remission in certain cases. However, EPP is a complex procedure with risks such as arrhythmias, blood clots, and complications like pneumonia.

Eligibility Criteria for EPP

EPP is now often reserved for patients with later-stage mesothelioma where the tumor has spread into the lung and who are otherwise fit for surgery. Lung function and the type of mesothelioma cells play a crucial role in determining a patient’s suitability for EPP.