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.
- 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.
- Not all patients who survive the
surgery are selected to receive radiotherapy or chemotherapy.
Those not selected are also excluded when calculating “survival
rates.”
- 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.
- 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.
- 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 ***
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