Extrapleural Pneumonectomy (EPP)
Extrapleural pneumonectomy is a radical surgical procedure for pleural mesothelioma that removes the affected lung, the pleural lining, the diaphragm on the affected side, and the pericardium (heart sac). It is one of the most extensive thoracic surgeries performed and is reserved for select patients with early-stage disease.
EPP aims to achieve macroscopic complete resection — removing all visible tumor — by removing the entire affected lung and surrounding structures where mesothelioma has spread. The diaphragm and pericardium are reconstructed with synthetic patches. The surgery typically requires 6–8 hours and a hospital stay of 1–2 weeks.
Patient selection for EPP is critical. Candidates must have early-stage (stage I–III) pleural mesothelioma, predominantly epithelioid cell type, adequate pulmonary reserve in the remaining lung, and good overall health. EPP is typically combined with chemotherapy and radiation therapy as part of a multimodal treatment plan.
EPP versus pleurectomy/decortication remains one of the most debated topics in mesothelioma surgery. EPP allows more aggressive tumor removal but carries higher morbidity, while P/D preserves the lung but may leave more microscopic disease. Learn more about comparing these surgical approaches.
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