Extrapleural Pneumonectomy

The extrapleural pneumonectomy is a surgery to remove the affected lung in patients with pleural mesothelioma. The EPP may extend life expectancy and improve a patientʼs quality of life. The extrapleural pneumonectomy (EPP) was the first surgical treatment option that significantly increased survival times for pleural mesothelioma patients. This surgery is generally used in early stage patients, but may be used in later stages in special cases.

Surgical Development
The extrapleural pneumonectomy was developed and perfected over a 30 year period by Dr. David Sugarbaker, during his time at Brigham and Women’s Hospital.

Eligible Candidates
The ideal candidate for an EPP is a patient with a stage 1 or 2 diagnosis who is in good overall health (good cardiac function, liver function, etc.).

Life Expectancy
A study conducted by Dr. Sugarbaker concluded patients having the surgery had an additional 19 month survival time after having an EPP. The average life expectancy of a typical mesothelioma patient is approximately a year or less.

Who is Eligible For an EPP?

Patients are carefully evaluated under several criteria before they are considered for an EPP. Patients must be healthy enough not only to undergo the surgery, but also to undergo the extensive recovery process.

Under the standards of Brigham and Womenʼs Hospital, overall health and functionality is more important than age. Although a patient may not be able carry on with normal day-to-day activities without experiencing symptoms, they may still be eligible for surgery. The minimum requirement of patients to undergo this surgery is that they are still able to care for themselves.
Eligibility is also determined by whether the patientʼs healthy lung is strong enough to handle all of the patientʼs breathing. Some late stage patients have even been deemed eligible for surgery in clinical trials.

Having healthy, normal heart function is also imperative as the heart and lungs work together to support the breathing process. Normal kidney and liver function is also required.
Patient Eligibility Tests

Age and performance assessment
Bloodchemistry
Liver function tests
Pulmonary function tests/quantitative ventilation-perfusion scan
Echocardiogram and electrocardiogram
CT-scan and MRI of chest
Pleural biopsy

Diagnosis is also important in selecting patients for an EPP. This surgery is typically performed on patients in early stages of pleural mesothelioma. It is rare, though not unheard of, for patients diagnosed past stage 2 pleural mesothelioma to be admitted for an EPP.
Generally, patients whose cancer has spread to lymph nodes and surrounding tissues or organs are not accepted for the surgery under the standards of Brigham and Women’s Hospital.

The purpose of the surgery is to prevent the cancer from spreading. Therefore, if the cancer has already spread, the risks may outweigh the benefits of having the procedure. These requirements are important to protect ineligible patients from potentially fatal surgical complications.

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