Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jun;5(11):232.
doi: 10.21037/atm.2017.03.82.

Extrapleural pneumonectomy (EPP) vs. pleurectomy decortication (P/D)

Hasan Fevzi Batirel  1
Affiliations
Review

Extrapleural pneumonectomy (EPP) vs. pleurectomy decortication (P/D)

Hasan Fevzi Batirel. Ann Transl Med. 2017 Jun.

Abstract

Surgical techniques for treatment of malignant pleural mesothelioma (MPM) have improved over the decades. The main surgical principle was accepted as macroscopic complete resection. This principle was achieved with extrapleural pneumonectomy (EPP) and extended pleurectomy/decortication (P/D). Mortality and morbidity are higher following EPP with supraventricular arrhythmias, pulmonary embolism, bronchopleural fistula and pulmonary failure being the most common, while prolonged air leak is frequent following P/D. Completion of multimodality treatment was also shown to be a prognostic factor. Many different neoadjuvant and adjuvant protocols were applied with limited effect on prognosis. While locoregional recurrence is more common following P/D, EPP patients typically recur in contralateral hemithorax and abdomen. Hemithoracic radiation following EPP was the only effective technique shown to decrease locoregional recurrence. However, neither surgical technique (EPP vs. P/D), nor types of multimodality treatment protocols were found to be prognostic in MPM. Epithelioid histology, metastasis to extrapleural lymph nodes and completion of multimodality treatment were prognostic in most of the series. In conclusion, based on the current evidence, the choice of a less morbid and mortal procedure (P/D) seems to be the logical choice in the treatment of MPM.

Keywords: Extrapleural pneumonectomy (EPP); malignant pleural mesothelioma (MPM); pleurectomy/decortication (P/D).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The author has no conflicts of interest to declare.

Figures

Figure 1
Figure 1
A left EPP specimen. (A) Costal surface; (B) En bloc resection of the pericardium (star) and diaphragm (arrow) has been performed along with parietal and visceral pleura and the left lung. EPP, extrapleural pneumonectomy.
See this image and copyright information in PMC

References

    1. Butchart EG, Ashcroft T, Barnsley WC, et al. Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients. Thorax 1976;31:15-24. 10.1136/thx.31.1.15 - DOI - PMC - PubMed
    1. Wanebo HJ, Martini N, Melamed MR, et al. Pleural mesothelioma. Cancer 1976;38:2481-8. 10.1002/1097-0142(197612)38:6<2481::AID-CNCR2820380637>3.0.CO;2-9 - DOI - PubMed
    1. Rice D, Rusch V, Pass H, et al. Recommendations for uniform definitions of surgical techniques for malignant pleural mesothelioma: a consensus report of the international association for the study of lung cancer international staging committee and the international mesothelioma interest group. J Thorac Oncol 2011;6:1304-12. 10.1097/JTO.0b013e3182208e3f - DOI - PubMed
    1. Sugarbaker DJ, Flores RM, Jaklitsch MT, et al. Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg 1999;117:54-63; discussion 63-5. 10.1016/S0022-5223(99)70469-1 - DOI - PubMed
    1. Sharkey AJ, Bilancia R, Tenconi S, et al. The management of the diaphragm during radical surgery for malignant pleural mesothelioma. Eur J Cardiothorac Surg 2016;50:311-6. 10.1093/ejcts/ezw045 - DOI - PubMed