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Extrapleural Pneumonectomy (EPP)

Extrapleural pneumonectomy (EPP) is a surgical procedure that removes the entire lung and some of the chest wall. It is typically used in patients who have mesothelioma, a type of cancer that forms in the lining of the lungs.

This type of surgery is typically performed on patients with advanced mesothelioma. It may be a treatment option if the cancer has spread to the lining of the lung or if other treatments have failed.

The surgery itself can take up to ten hours and requires general anesthesia. The patient may be connected to a ventilator to help with breathing after their procedure. Recovery takes a minimum of several weeks, but it’s not uncommon for it to take several months.

Extrapleural pneumonectomy is often used as a last resort in patients who cannot undergo chemotherapy or radiation therapy due to other health conditions.

Benefits of an Extrapleural Pneumonectomy

Extrapleural pneumonectomy is a surgical procedure that removes the entire lung and pleura, the chest lining around the lung.

It is usually recommended for people who have mesothelioma that has not spread to lymph nodes or distant organs. This surgery aims to remove any tumor in the pleura and lungs while preserving as much lung function as possible.

The surgery may be recommended if:

  • the cancer cannot be surgically removed from the impacted areas
  • the cancer has not spread to other parts of the body outside of the chest
  • the cancer has come back after radiation therapy or chemotherapy

The procedure has been reported to be successful in removing mesothelioma in some cases, but it can also cause complications including infection and scarring.

Extrapleural pneumonectomies should be considered for patients who have:

  • a pleural effusion (fluid in the chest cavity)
  • a malignant pleural effusion (fluid with cancer cells)
  • X-rays showing diffuse thickening of the pleura (the lining of the lungs and chest cavity)
  • chest pain or shortness of breath

It can slow disease progression, improve quality of life, and is particularly indicated for people who are having difficulty breathing.

Alternatively, extrapleural pneumonectomies can be used as a form of palliative care. This means that surgeons may perform one to alleviate a person’s symptoms, even if it will not remove all of the mesothelioma cells.

The Extrapleural Pneumonectomy Procedure

The procedure involves removing the lining between the lung and chest wall, which includes some of the pleura – an organ that lines the lungs and chest cavity. The idea behind this surgery is to remove any cancerous cells that are present on this lining and also prevent them from spreading to other parts of the body.

In an extrapleural pneumonectomy, you will be put under general anesthesia. This means you will not be conscious throughout the operation.

The surgeon will then open the chest cavity, either at the front, in a process called a sternotomy, or on the side, known as a thoracotomy. The incision will be around 9 inches.

Then, following a visual inspection, the surgeon will remove all visible signs of mesothelioma. They will remove some or all of the following:

  • The lung
  • The pleural lining of the chest
  • The lining of the heart
  • The diaphragm

After this has all been removed, the surgeon will use artificial materials to rebuild the diaphragm and pericardium.

Extrapleural Pneumonectomy Risks and Side Effects

The risk of complications after an extrapleural pneumonectomy can vary, depending on factors such as age, general health, and extent of surgery.

People who are good candidates for an extrapleural pneumonectomy are those who are in otherwise good health, with adequate heart and lung function. This is because of the additional load placed on the remaining lung after the procedure.

Around 66% of people who have an extrapleural pneumonectomy experience some form of complication. These may include:

  • acute respiratory distress syndrome
  • chest pain
  • breathing difficulties
  • coughing up blood or blood clots
  • pain in the neck, shoulder, and arm
  • nausea/vomiting
  • heart palpitations
  • pneumonia
  • pulmonary embolism
  • respiratory infections
  • infection at the incision site

Death is also a risk of this procedure, with between 4 to 15% of people who undergo extrapleural pneumonectomies dying due to complications of the surgery.

Extrapleural Pneumonectomy Recovery

You will be kept in the hospital for around two weeks after your surgery. This varies depending on your overall health and if any complications occurred. You will have a pulmonary rehabilitation program to follow for a number of weeks or months. This will help your remaining lung adapt to the changes.

You’ll also have regular checkups with your doctor during this time period, as well as taking medication such as antibiotics or painkillers.


Read on to learn the answers to some commonly asked questions about extrapleural pneumonectomies.

What is an extrapleural pneumonectomy?

The surgery removes the diseased lung and other parts of the body. The diseased lung is removed to prevent cancer metastasis in other body parts, including part of the pericardium (the membrane covering the heart), part of the diaphragm (the muscle between the lungs and the abdomen), and part of the parietal pleura (the membrane lining the chest).

What is the life expectancy of a person with one lung?

Living with one lung is not as difficult as you might think. It does not require any special treatment or medication. A person with one lung can live for many years. The life expectancy of a person with one lung varies due to many factors including overall health, age, and surgical complications.

The only difference is that people with one lung will have to take some precautions, such as slowing down while they adapt to the changes in their breathing abilities.

What is difference between lobectomy and pneumonectomy?

A lobectomy is a surgical procedure that removes part of the lung. A pneumonectomy is a surgical procedure that removes all of the lung, including the pleura and chest wall.

Next Steps if You’ve Been Recommended an Extrapleural Pneumonectomy

If you’ve been recommended an extrapleural pneumonectomy, you should first talk to your doctor about whether this surgery is right for you. You should also ask your doctor about any other treatment options, such as chemotherapy or radiation therapy. Your doctor may recommend a second opinion from another specialist to help make sure that you’re getting all the information available.