Note: This blog was updated 05/21/2021 with data about survival rates for P/D and EPP.

For the past decade or so, there has been a shift in surgical choice for malignant mesothelioma.

Extrapleural pneumonectomy (EPP) started as the preference, but pleurectomy with decortication (P/D) is now far and away the top option.

A study from researchers at Mount Sinai Cancer Center in New York detailed the use of minimally invasive surgery for mesothelioma. One of the authors is Dr. Raja Flores, the chief thoracic surgeon of the institution.

The report includes an interesting pair of statistics. This data upholds the theory that mesothelioma experts believe more in P/D than EPP, both for safety and survival.

 

How Often Is Each Surgery Used?

EPP and P/D are aggressive surgeries for pleural mesothelioma. They can both add multiple years to a patient’s life.

A lot of the debate surrounds safety and quality of life. EPP removes the lung — in addition to the pleura (cavity between the lungs and chest wall), diaphragm (muscle below the lungs) and pericardium (lining around the heart).

P/D removes the pleura, and possibly the diaphragm and pericardium, but leaves the lung. Most studies report fewer complications with P/D and higher quality of life due to patients having both lungs.

From 1995-2012, doctors slightly preferred EPP for mesothelioma:

  • EPP accounted for 53.4% of surgery cases.
  • P/D accounted for 46.6%.

From 2007-2017, those numbers shifted dramatically:

  • P/D was used in 81.3% of cases.
  • EPP was used in 18.7% of cases.

 

P/D Leads to Better Survival Than EPP

A study recently published in the Annals of Thoracic Surgery detailed survival trends for each pleural mesothelioma surgery. One of the co-authors, Dr. Anne Tsao, is a renowned mesothelioma specialist at MD Anderson Cancer Center in Houston, Texas.

Most patients in the study underwent EPP (66%), but the survival far favored P/D surgery. The lung-sparing option had a median survival of 22 months, compared to just 15 months for EPP.

Additionally, the perioperative mortality rate for P/D was nonexistent, meaning none of the 95 patients died within 30 days after their surgery. The mortality rate for EPP was 11%.

 

Find a Cancer Center for Mesothelioma Surgery

There’s still a need for EPP as an option. The study reports EPP was more viable for younger patients and those with fewer or no comorbidities, as they can withstand losing a lung. The decision between the two may involve the stage of a mesothelioma case.

If you wish to learn more about mesothelioma surgeries, contact our nurse and patient advocate. Karen Ritter is reachable at karen@mesotheliomaguide.com. She can help you find a cancer center to undergo one of these two surgeries: EPP or P/D.

    Sources & Author

    • Extrapleural Pneumonectomy versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma. Annals of Surgical Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/33971174/. Accessed: 05/21/2021.
    • VATS Pleurectomy Decortication Is a Reasonable Alternative for Higher Risk Patients in the Management of Malignant Pleural Mesothelioma: An Analysis of Short-Term Outcomes. MDPI. Retrieved from: https://www.mdpi.com/2072-6694/13/5/1068/htm. Accessed: 04/06/2021.
Devin Goldan image

About the Writer, Devin Golden

Devin Golden is the content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.

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    Sources & Author

Picture of Devin Golden

About the Writer, Devin Golden

Devin Golden is the content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.