Straight Talk about Mesothelioma, a blog series created by Michael T. Milano, M.D., Ph.D., a radiation oncology specialist, as a resource for mesothelioma patients and their loved ones.


The key to maximizing the lifespan of a mesothelioma patient is discovering the cancer as soon as possible. The earlier the disease is detected, the more treatment options that are available — including radiation, chemotherapy, and various surgical procedures.

While the 5-year survival rate for mesothelioma is pretty low (just 10 percent), some patients are candidates for aggressive surgical therapy. The most aggressive surgery, extrapleural pneumonectomy (EPP), involves removal of an entire lung, parts of the diaphragm, portions of the linings of the chest and heart, and nearby lymph nodes.

Who Is an Extrapleural Pneumonectomy (EPP) candidate?

Because it’s fairly dangerous, EPPs are only performed on patients who are deemed sufficiently healthy to undergo such an invasive procedure. It’s also limited to pleural mesothelioma patients in the early stages of the disease; i.e. among those with mesothelioma involving the lining of the lungs called the pleura, rather the peritoneum, or abdomen. When combined with radiation and chemotherapy, a successful EPP can significantly prolong a patient’s life expectancy — sometimes by a factor of years, rather than months.

Critically, an EPP can only be performed if the cancer has not yet spread to lymph nodes or surrounding organs. This is because the cancer needs to be localized in order to be effectively removed; once the cancer has spread to the lymph nodes, it likely has already spread to other organs or regions of the body (even if not seen on CT, MRI or PET).

What Are the Risks of an Extrapleural Pneumonectomy (EPP)?

For patients that are fit for an EPP procedure, there are still many risks, including internal hemorrhaging (bleeding), pneumonia, kidney failure, blood clots, infection, and heart failure. It is up to you and your doctor to determine if the benefits outweigh these risks. According to the surgery department at the University of California, roughly 6 percent of patients undergoing an EPP die during or immediately following the surgery. Recovery can last months, and even then there’s a strong chance that the cancer will return.

For these reasons, EPP is viewed as a desperate measure, by some doctors who may advise against it outright. Alternative procedures, such as a mesothelioma pleurectomy (removal of the lining of the lung and chest cavity) can also prolong a patient’s life without requiring the loss of an entire lung and other critical organ components.

What Are the Benefits?

For a disease as terminal as mesothelioma, the prospect of adding years to a patient’s life is extremely alluring. As it stands, EPP is 1 of only 2 potentially curative surgeries for pleural mesothelioma — the other being a Pleurectomy/Decortication (P/D). Some doctors believe that that EPP has a greater chance of completely curing mesothelioma (by removing all tumors) than other surgical treatment methods.

However, the average survival rate for EPP patients is still only 12-22 months, according to one study by researchers at Macquarie University in Australia. The survival rate extends to 13-29 months for patients undergoing the less invasive P/D procedure.

The Patient Always Comes First

Surgery is always a risky procedure, but for many cancer patients it is the only way to prolong their life expectancy — let alone completely cure them. For that reason, doctors always try to maintain the expectations of their patients, and to remind them that the riskiest path is not always the wisest.

When it comes to treating mesothelioma, the primary goals are to maximize the patient’s lifespan and control the spread of the disease. It’s a nasty, unforgiving disease, and, unfortunately, it’s often the case that the comfortable management of symptoms is preferable to the pain and stress of a risky, invasive procedure like an EPP. Either way, if you or a loved one has been affected by mesothelioma, it’s critical that you talk to your doctor about the best course of action.