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Extrapleural pneumonectomy (EPP)

Extrapleural pneumonectomy (EPP) is a surgical procedure for patients diagnosed with pleural mesothelioma—a specific form of cancer that develops in the lungs. The surgery attempts to remove the cancer entirely, or to prevent or relieve symptoms. But the fact is, in many cases tumors will have spread too far throughout the body to be removed completely at this point in the progression of the disease. Unfortunately, surgeons will not always know for certain the extent of the cancer’s spread until the operation has begun.
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EPP Is Not for Everyone

There is no ignoring the fact that an EPP is a serious, major procedure. Surgeons typically choose this operation for patients with early-stage mesothelioma who are in otherwise good health, with strong lung function, and whose cancer has not spread to the lymph nodes or any tissues or organs.

Patients often must undergo several tests beforehand to ensure they are healthy enough to tolerate the surgery. The operation is technically complex and should be performed by an experienced surgeon, ideally one associated with a leading medical facility.

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What to Expect During an EPP Operation

Once the patient has received general anesthesia, the surgeon makes an incision, approximately 9 inches long, to open the chest cavity and remove the visible cancer. This incision is made either down the front of the chest or in a sweeping arc underneath the armpit from the rear shoulder blade to the front ribs. To get rid of as much of the cancer as possible, the surgeon must often remove the diseased lung along with the pleural lining of the chest and heart (pericardium), the diaphragm (the muscle between the lungs and the abdomen), and any lymph nodes nearby. Then the diaphragm and pericardium are reconstructed.

Patients can expect to remain in the hospital for up to 2 weeks, and should allow an additional 6-8 weeks’ recovery time after discharge from the hospital.

While it is no small matter to remove a patient’s lung, an extrapleural pneumonectomy is considered an effective treatment to control mesothelioma when performed on suitable patients. It can slow the progression of the disease and greatly improve a patient’s quality of life. When this surgical procedure is combined with radiation and chemotherapy, it can greatly increase a patient’s life expectancy.

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