Doctors Question Whether EPP Is The Best Option
EPP: Do the dangers outweigh the benefits?
It is well documented that mesothelioma is a rare, terminal cancer that
at this time has very few treatment options. Currently the extrapleural
pneumonectomy (EPP) seems increasingly popular among many thoracic
surgeons who treat mesothelioma patients.
However, few doctors have stepped back and pondered why the EPP is "superior" to other options, whether there is data to support that upbeat assessment, or whether the by all accounts "radical" surgery does confer on balance benefits to the patient.
Recent publications by Drs. Treasure and Cameron do attempt to address these important issues. Below is a summation of the more sobering observations from these two outspoken opponents of the EPP.
EPP survival statistics are misleading.
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The "survival rates" reported by EPP reports don't include those patients who died during surgery. (5.9-14% of patients die during or right after EPP) If you die, you don't count.
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Not all patients who survive the surgery are selected to receive radiotherapy or chemotherapy. Those not selected are also excluded when calculating "survival rates."
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The surgery is effective, if at all, only with adjuvant chemotherapy or radiotherapy. You won't know until AFTER the surgery whether you are eligible to receive further treatment. A meaningful predictor of a surgery's efficacy should be available BEFORE your lung, diaphragm and other body parts are removed.
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There is no statistical data to support a claim that survival for a patient who undergoes an EPP is any longer than for a patient who has no surgical intervention.
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There is no statistical data which shows an EPP confers any superior benefit to other surgical options such as a pleurectomy-decortication (P/D). In fact, a P/D appears to exhibit markedly less perioperative morbidiy (0-5.4%) compared to the frightening frequency of patients who die during EPP.
The history of radical surgeries such as EPP shows that radical surgeries are nearly always the wrong approach. Why would a surgeon recommend EPP? Some surgeons are simply unaware of other options. Others have a "Mount Everest" view of this surgery. EPP is possibly the most dangerous of thoracic surgeries. An ambitious surgeon will perform it for the sake of performing it. There are no proven benefits an EPP confers on the actual patient, beyond anecdotal accounts from the few long term survivors.
Please click on the seminal articles below, as well as others on our website.
Treasure, Tom, MD, Utley, Martin, PhD. Ten traps for the unwary in surgical series: A case study in mesothelioma reports, The Journal of Thoracic and Cardiovascular Surgery, June 2007
Cameron, Robert B. MD. Extrapleural Pneumonectomy Is the Preferred Surgical Management in the Multimodality Therapy of Pleural Mesothelioma: Con Argument, Annals of Surgical Oncology, July 2006
*** POSTED SEPTEMBER 9, 2007 ***