EPP vs P/D: Which Surgery Is Right For Me?

epp-vs-pd-surgery-mesothelioma

Surgery is one standard form of mesothelioma treatment. The goal is to remove mesothelioma tumors to prevent or reduce spreading. Two primary surgical treatments for pleural mesothelioma include extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D).

Below we will discuss the similarities and differences between the EPP vs. P/D surgery to help diagnosed individuals understand which one is right for them.

EPP vs. P/D Surgery Options for Pleural Mesothelioma

If you have been recently diagnosed with pleural mesothelioma, you may be eligible for surgery or other treatment options. While discussing surgical options with your doctor, it can be helpful to have background knowledge on the 2 possible procedures to help you make more informed treatment decisions.

Extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D) are the 2 main surgical interventions for pleural mesothelioma. Many patients will need to choose between the EPP vs. P/D surgery after a mesothelioma diagnosis.

Both surgeries are used to treat stage 1 and 2 pleural mesothelioma, with the main goal of removing the diseased tissues from the chest cavity and pleural lining of the lungs. Removing cancerous tissues in these areas reduces the chances that mesothelioma spreads to nearby healthy tissues and organs.

Although similar, these surgeries vary in terms of their procedure and eligibility requirements.

Extrapleural Pneumonectomy (EPP)

EPP is a much more extensive surgery compared to P/D, as it involves removing the diseased lung, along with the tissue lining the lungs (pleura) and heart (pericardium). Most often surgeons also remove part of the diaphragm and surrounding lymph nodes.

Thoracic surgeons with extensive experience treating pleural mesothelioma perform this particular procedure. The total operation takes around 3 hours.

Recovery time is rather long, generally requiring 2 weeks of hospitalization and an additional 3 months of healing at home. During this time, patients will feel very sore and uncomfortable due to the extensive swelling within their upper body.

Patients will require assistance from family or caregivers, as simple tasks may become more difficult and mobility will be limited.

Who Is Eligible for EPP?

Due to the extensive nature of the surgery, doctors need to assess patients to ensure they are healthy enough to undergo the operation and recovery. Doctors run numerous tests to measure overall fitness, with specific tests to understand a patient’s lung capacity.

Once the affected lung is removed, a strong and high functioning single lung will be critical for patients to breath without assistance. If the goal of the surgery is to cure mesothelioma (remove all visible signs), doctors may scan the chest to make sure the cancer has not spread to other areas in the chest cavity.

Pleurectomy With Decortication (P/D)

P/D is a lung-sparing procedure that is split into 2 parts:

  1. Pleurectomy: Surgeons first perform a pleurectomy, which removes the lung lining (pleura) and in some cases the heart lining (pericardium) and part of the diaphragm as well. If parts of the chest cavity tissue are affected, these tissues may be removed in the first part of the procedure as well.
  2. Decortication: During decortication, surgeons use a variety of techniques to remove visible and unseen mesothelioma tumors to reduce recurrence rates.

Thoracic surgeons who specialize in pleural mesothelioma treatment conduct the P/D. The entire operation takes approximately 5 hours.

Recovery time is quicker than EPP, with expected hospital stays of around one week following surgery. At home healing usually takes around one month, and during this time patients will need similar (but not as much) support from family members or care-aids.

Who is Eligible for P/D?

Eligibility requirements for P/D are similar to those of EPP, although high lung capacity is not as imperative, it will help with overall recovery. Doctors run tests and assessments to ensure patients are in good overall fitness and health. Doctors will also confirm a tumor’s location before deeming patients as eligible for this specific surgery.

What Are the Risks?

As with any surgery, there are risks that patients need to be aware of. The mortality rates (the percentage of people who do not survive the procedure) are higher for EPP at 2-7%, with P/D showing 1-5%.

Other risks for EPP include a lower post-surgery quality of life, due to loss of a whole lung. Recurrence of mesothelioma in other locations within the chest cavity is a risk within both procedures, although it is lower in EPP as all the infected tissue is removed via total lung resection.

It’s under debate within the medical community which of the 2 surgeries is most effective.

Some practitioners believe that EPP is too extreme, while others support it given the lower recurrence rate following total lung removal. Regarding P/D, other doctors see the benefits of the lung-saving procedure, as it’s linked back to a higher quality of life and lower morbidity rates.

Choosing between the EPP vs. P/D surgery requires you to consider many factors. If you want to discuss your options in more detail, get in touch with our Justice Support Team today. Call us at (888) 360-4215 or request a FREE Mesothelioma Justice Guide to review all pleural mesothelioma treatment options.

Author:Stephanie Kidd

Editor-in-Chief of the Mesothelioma Justice Network

Stephanie Kidd

Stephanie Kidd works tirelessly as a dedicated advocate for the vulnerable and underrepresented. Stephanie worked as a copywriter for an agency whose focus was communicating safety procedures on construction work sites. With her extensive background in victim advocacy and a dedication to seeing justice done, Stephanie works hard to ensure that all online content is reliable, truthful and helpful.

Last modified: May 29, 2019

View 3 Sources
  1. University of California San Francisco, “Extrapleural Pneumonectomy.” Retrieved from: https://thoracic.surgery.ucsf.edu/conditions--procedures/extrapleural-pneumonectomy.aspx. Accessed on June 20, 2018
  2. Annals of Translational Medicine, “Pleurectomy and decortication.” Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497109/. Access on June 20, 2018.
  3. Thoracic and Cardiovascular Surgery, “Technique of Pleurectomy and Decortication.” Retrieved from: https://www.optechtcs.com/article/S1522-2942(10)00136-4/abstract. Accessed on June 20, 2018.