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.


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 She can help you find a cancer center to undergo one of these two surgeries: EPP or P/D.

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    Sources & Author

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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.