Surgical Choices: Extra Pleural Pneumonectomy vs Pleurectomy
A pleurectomy / decortication (P/D) is a surgical procedure that removes the involved pleura and frees the underlying lung so that it can expand and fill the pleural cavity.
Which is the preferred treatment?
To compare the outcomes of extrapleural pneumonectomy (EPP) and radical pleurectomy / decortication (P/D) for N2 malignant pleural mesothelioma (MM). More...
Malignant Mesothelioma a Comprehensive Review (10/06)
The incidence of malignant mesothelioma continues to increase, but the disease remains difficult to detect early and treat effectively. When possible, surgery (video-assisted thoracoscopy, pleurectomy / decortication, or extrapleural pneumonectomy) is utilized. Effects on underlying structures limit application of radiation therapy, but some systemic agents are beginning to enhance survival. More...
Society of Thoracic Surgeons 42nd Annual Meeting. January 30 - February 1, 2006. Chicago, Illinois
Improved survival with Interferon Alpha maintenance therapy following pleurectomy / decortication and radiation for malignant pleural mesothelioma. As presented by Dr. Robert Cameron. More...
pleurectomy / decortication Surgery Preferable to Extra-Pleural Pneumonectomy
The September/October issue of Thoracic Surgery News reports that the two surgical options typically used for pleural mesothelioma produce similar outcomes. However, the pleurectomy / decortication surgery spares the entire lung, and removes the the pericardium and diaphragm only when necessary. More...
Doctors Question Whether EPP Is The Best Option (9/8/07)
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. More...
Treatment of Malignant Pleural Mesothelioma (04/07)
In Japan, it is predicted that mesothelioma will rapidly increase in the future. Malignant pleural mesothelioma that accounts for approximately 90% of mesothelioma as a whole has a median survival time of approximately nine months which is considered a poor prognosis. As for the treatment of this disease,extrapleural pneumonectomy or pleurectomy / decortication are available for those patients who can be surgically operated on. However, since a complete cure rate is low when only surgical treatment is performed, generally a multimodality treatment is performed wherein chemotherapy and/or radiotherapy are combined. More...
Is Extrapleural Pneumonectomy the Preferred Surgical Management in the Multi Modal Treatment of Mesothelioma? Dr. Cameron weighs in against the EPP (Annals of Surgical Oncology, 2006) More...
- No evidence the EPP is superior to lung-sparing P/D
- Both surgeries carry potentially serious risks
- Only experienced surgeons should attempt either surgery
- "The EPP should not become the (Sir Edmund Hillary) operation of Thoracic Surgery: being done simply because it is there and because it can be done
Surgical Management of Malignant Pleural Mesothelioma: a Systematic Review and Evidence Summary (1/16/06)
Canadian Lung Cancer Care Program concludes it is "impossible" to call the Extrapleural Pneumonectomy (EPP) superior to the pleurectomy / decortication in the absence of a randomized controlled clinical trial. More...
Consensus Report: Pretreatment Minimal Staging and Treatment of Potentially Resectable Malignant Pleural Mesothelioma (1/16/06)
International Group of Consensus Group concludes 1) no evidence EPP is superior to P/D, 2) no evidence that multi-modal therapy is superior since clincial trial not appropriately designed and risk of selective patient recruitment, 3) a new, uniform clinical staging system is needed, along with a large clinical database/registry. More...
"Surgical Treatment of Malignant Pleural Mesothelioma - A Review," Ruth, et al, Chest; 2003; 23:551-561. (Posted 5/21/04) More...
- Median Survival after Pleurectomy is 9 to 20 months.
- Median Survival with Extra-Pleural Pneumonectomy is 9 to 19 months.
- When comparing EPP with pleurectomy / decortication, a lower recurrence rate has been reported (10% after EPP vs 52% after pleurectomy), but EPP patients have higher rates of tumor relapses in distant sites of body.
- Mortality rate for EPP is around 5% and morbidity is between 25-50%. For pleurectomy / decortication, mortality rate is 1-2%.
- Intrapleural chemo approach has probably not shown full potential.
- The combination of complete surgery, whether EPP or P/D, along with radiation therapy seems promising but only in selected patients.
- To evaluate merits of treatment options, need to conduct a radmonized phase II clinical trial, comparing defined treatment arm with a no treatment arm.
- There does not seem to be a survival benefit for patients undergoing EPP in comparison to patients undergoing pleurectomy.
The Management of Malignant Pleural Mesothelioma; Single Centre Experience in 10 years (03/02) Eur J Cardiothorac Surg. 2002 Aug
Malignant pleural mesothelioma (MPM) is an asbestos-related disease of the pleura with a survival time without treatment ranging from 4 to 12 months. The objective of this study is to review our experience in selection of MPM patients for various modalities of treatment. More...
Malignant Pleural Mesothelioma: Surgical Roles and Novel Therapies, preface by RGW (2/7/02)
Dr. Harvey Pass' comprehensive review of the literature on mesothelioma diagnosis and treatment is a must read, for both doctors and patients alike. The article carefully reviews the diagnostic and therapeutic options for patients from the time of initial symptoms onward. More...
pleurectomy / decortication versus Extra Pleural Pneumonectomy Which Would You Choose? (10/2/01)
Klaus Brauch has done more than any patient I have ever known to search for the Truth. He has interviewed the best and brightest doctors. He has found and read with amazing comprehension the published literature. He has spoken to other mesothelioma patients. He has zeroed in on perhaps the most critical question, that is, would an extra-pleural pneumonectomy (EPP) for a patient with early stage, epitheliod type and negative lymph nodes offer a better chance of long-term survival than a pleurectomy / decortication? More...
Current Therapy for Mesothelioma, Sugarbaker et al, 1997.
The Division of Thoracic Surgery at the Brigham and Women's Hospital in Boston Massachusetts provides diagnostic and treatment services to patients with benign and malignant neoplasms and other disorders of the lung, esophagus, mediastinum and chest wall. Their website provides complete review of services available, how to set up an appointment, whom to call, and how to prepare for surgery and rehabilitate afterwards. More... Check it out. http://www.chestsurg.org