An extrapleural pneumonectomy, or EPP, is a surgical procedure in which a patient undergoes a thoracotomy, or the incision into the chest, for the purpose of removing a diseased lung or other tissue. Usually this is done if a patient is suffering from mesothelioma or lung cancer.

When is EPP Recommended?

Patients with mesothelioma are not often diagnosed until the malignancy has spread from the pleural area of the lungs to other tissues. Only in the disease's early stages, when the cancer cells have not reached the nearby lymph nodes, and metastasizing has not occurred will a patient normally be scheduled for EPP. If metastasizing has occurred the cancer cells are transported to other organs through the lymphatic system and the removal of a tumor at its original location is not deemed proper as the disease has advanced to other vital areas.

In early stage mesothelioma or other lung cancer the disease often manifests in the pleural lining. If detected early enough a thoracotomy, or chest incision, gives the surgeon access to the affected tissue. The extrapleural pneumonectomy is performed through this incision and the cancerous tissue is removed. In most cases this tissue will be that of the mesothelium itself, although an entire lobe of one lung may be removed if the tumor has spread to this area.

Performing the Operation

The surgeon will open the chest cavity, and if necessary make cuts to the breastplate or ribs. All of the cancerous tissue is removed from the affected areas, which may be the mesothelium alone or involve the lungs, diaphragm or even the lining of the heart. During the procedure a breathing tube is inserted through the trachea and specialized ventilator equipment feeds oxygen to one lung while the affected lung is deflated. The heart is monitored constantly because of the added pressure on a single lung to provide oxygen during the operation.

Recovery from Extrapleural Pneumonectomy  

Patients undergoing this surgery usually recuperate in the hospital for two weeks or more. Afterward there may be additional bed rest for up to two months. Also, an EPP operation may be the first step in treatment of lung cancer or mesothelioma and chemotherapy may be suggested after the surgery. Patients with Stage 3 or Stage 4 mesothelioma are not normally scheduled for EPP unless growing tumors in other parts of the chest cavity are removed in order to relieve the individual of pressure being put on nearby organs and tissue.

References:
Cardiothoracic Surgery Network

University of California General Thoracic Surgery