Lung-Saving P/D vs. Radical EPP
There are two surgical procedures which are used in the treatment of pleural mesothelioma:
- the Extrapleural Pneumonectomy and
- the Pleurectomy/Decortication.
The Extrapleural Pneumonectomy
The Extrapleural Pneumonectomy, or “EPP”, is a radical procedure which involves the surgical removal of the entire lung, a portion of the diaphragm (the muscle located below the lung) and the pericardium (the lining of the heart).
Because of the radical nature of this procedure, and the fact that the patient will be left post-operatively with only one lung, it can only be performed on patients who meet certain criteria such as good cardiac and pulmonary functioning.
Pleurectomy / Decortication
The Pleurectomy/Decortication, or “P/D”, is a less radical procedure because it involves the surgical removal of the tumor and the pleura, but not the lung. The procedure typically takes much longer to perform as the surgeon carefully separates the tumor from the lung and repairs any damage to the diaphragm so that the patient will continue to enjoy the use of the affected lung. Because it is less radical than the EPP, the P/D has a much lower rate of surgical mortality and can be performed on patients who would not be eligible for EPP.
Despite the benefits of P/D vs. EPP, EPP has been the most frequently used surgery for mesothelioma. As more information has been published regarding reduced surgical mortality, enhanced post-surgery quality of life and comparable if not better survival with P/D, more and more surgeons are recommending P/D over EPP.
Dr. Robert Cameron was the innovator of the lung-saving P/D procedure for mesothelioma and has performed the procedure on hundreds of patients to date.
Below, Dr. Cameron shares his opinions regarding P/D vs. EPP.
P/D, not EPP, is the Preferred Surgical Treatment for Pleural Mesothelioma
“EPP is a very radical procedure in which a surgeon goes into the chest through a large incision and virtually cuts out the lung and strips the tumor off of all the surfaces. The lung is an innocent bystander underneath the tumor, but is removed along with the tumor in order to theoretically get better clearance.
P/D involves opening the chest and removing all visible tumor. Instead of removing the lung, you carefully separate the tumor from the healthy lung. This can be done very completely so it provides just as much tumor clearance as taking out the lung in an EPP. It does so with much less sacrifice of lung function and risk of having surgical complications that result in bad outcomes and even death.
Another advantage of P/D over EPP is that P/D allows you to limit the operation site to the areas of tumor. An EPP often expands the surgery into new places where there is no tumor. This can cause the tumor to spread. In P/D, we leave barriers in the form of the diaphragm, pericardium and chest wall, between tumors and other areas to reduce the risk of spreading.
“Do No Harm”
My philosophy has always been: ‘do no harm.’ Taking out a lung does harm and there is absolutely no benefit to the patient. Doing a bigger operation makes no sense from an oncology standpoint, because a surgeon cannot rid a mesothelioma patient of every last cancer cell and cure them – that won’t happen. Once you accept that, then you can understand why P/D is the best surgical option with the least side effects, the least chance of dying and a better chance of getting as much tumor clearance as possible.”
Publications from Dr. Cameron on P/D vs. EPP:
“Extrapleural Pneumonectomy is the Preferred Surgical Management in the Multimodality Therapy of Mesothelioma: The Con Argument” (Annals of Surgical Oncology, 2006) Click here.
“Improved Survival with Interferon Alpha Maintenance Therapy
Following pleurectomy / decortication and Radiation for Malignant Pleural Mesothelioma,” as presented by Dr. Robert Cameron to the Society of Thoracic Surgeons, January 30, 2006. Click here
Anatomy of a Successful P/D (photos).
Dr. Robert Cameron, September 13, 2005 Click here
UCLA Proposes Comprehensive Mesothelioma Translational Research Program (5/10/04) Click here
Additional Publications on P/D vs. EPP: Which is the preferred treatment? Click here