The Radical Surgery Procedure Extrapleural Pneumonectomy (EPP) Is Controversial, At Best, As A Treatment Of Malignant Pleural Mesothelioma

Extrapleural pneumonectomy (EPP) as a surgical treatment of malignant pleural mesothelioma became popular in the 1990s due, in part, to a number of papers authored by the renowned Dr. David Sugarbaker.

Now, however, that particular surgery option for mesothelioma treatment has fallen out of favor in the medical field, according to an April 2014 article, “Radical Surgery for Mesothelioma: Still Controversial”, published on the Medscape web site (free registration required).

From this recent article:

“There is doubt about whether there is any survival or symptomatic benefit from [extrapleural pneumonectomy (EPP)] surgery, but we know that there is harm,” say a group of experts in a recent editorial in Thorax (2014;69:194-197).

When mesothelioma patients ask about surgery, the “default position for clinicians should be to encourage recruitment into clinical trials,” they wrote. The authors were Avijit Datta, MD, from the Department of Respiratory Medicine in York Teaching Hospital, and 3 colleagues from the United Kingdom, including senior author Tom Treasure, MD, from the Clinical Operations Unit at University College London….

“In my opinion, EPP has been proven to have net harm but has not been proven to have any benefit and, on average, it does not prolong life,” Dr. Treasure said. He also admitted that, while he has carried out many other thoracic surgical procedures, he has personally never done an EPP, because it is drastic surgery “that made no sense at all…. I thought it was irrational, and the evidence was never there.”…

The “milder and gentler” option of [extended pleurectomy/decortication, known as the EP/D procedure,] spares the lung, which enables the patient to breathe better for longer, so it may allow patients to have a better quality of life for the time they have left, Dr. Treasure said. There is also the “even milder” approach of debulking keyhole surgery, as explored in the MesoVATS trial, which has shown that this surgical approach improves quality of life, although it does not prolong survival.

Be assured that we will continue to monitor developments regarding malignant pleural mesothelioma treatments.

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