During an EPP, a surgeon removes the entire lung — and all of its protective lining — affected by pleural mesothelioma. Depending on how far the disease has metastasized or spread, a surgeon may also remove parts of the lining of the heart, diaphragm, and nearby lymph nodes. The goal of an EPP — and the reason a surgeon removes the entire lung — is to remove as much of the cancer as possible, and to prevent mesothelioma from recurring.
Benefits of an EPP
Improved Prognosis: The EPP is one of the best ways for pleural mesothelioma patients to live longer. Most patients add years to their prognosis after having the procedure.
Better Quality of Life: Since the EPP removes the majority of mesothelioma in the chest, patients experience fewer symptoms. This makes their quality of life better after an EPP.
Are You Eligible for an EPP?
Like any major surgery, you must be eligible to have an EPP. The EPP is an intensive procedure that requires patients to be healthy enough to withstand and recover from, the surgery.
Though the eligibility requirements for an EPP vary between treatment centers, there are several general requirements:
- Patients must be in good overall health with a strong heart and well-functioning lungs.
- Both the heart and remaining lung must be able to make up for the loss of the cancerous lung.
- Imaging tests must show that the mesothelioma is limited to one side of the chest.
A specialist will determine a patient’s eligibility for the EPP when the patient is diagnosed. Because the patient’s diagnosis affects his or her treatment options, it’s important to make sure the diagnosis is accurate. Getting a second opinion from an experienced doctor is extremely important for patients deemed ineligible for surgery because a second opinion may determine otherwise.
What Can You Expect?
To begin an EPP, an anesthesiologist administers general anesthesia. The surgeon then makes a 9-inch-long incision to access the chest cavity. He’ll use either a sternotomy (an incision made on the front of the chest) or a thoracotomy (an incision made on on the side).
After completing the incision, the surgeon inspects the chest cavity. Affected organs and tissue that may be removed during an EPP include:
- Lung affected by mesothelioma
- Pleura (the lining of the lung)
- Pericardium (the lining of the heart)
- Nearby lymph nodes
Multimodal Therapy and the EPP
Most surgeon combine the EPP with one or two other treatment options — like chemotherapy or radiation therapy — in a multimodal therapy. Combining more than one treatment maximizes the effect of all the procedures involved. For example, applying radiation therapy before an EPP shrinks the tumor and makes it easier to remove.
Doctors recently developed a multimodal therapy, called Surgery for Mesothelioma After Radiation Therapy (SMART), that uses intense radiation shortly before an EPP with amazing results.
SMART produced a 3–year survival rate of 84 percent, meaning 84 percent of patients who had SMART survived 3 years after the procedure.
Recovering from an EPP
Recovery from the EPP begins shortly after surgery. In the first few hours after the procedure, nurses will monitor the patients vitals. The nurses keep a close eye on the patients breathing, pulse, and blood pressure for signs of post-operative complications. Patients also have to use a respirator to help the transition into breathing with one lung.
Total in-hospital recovery time can take up to two weeks. During this time patients start physical strengthening exercises, usually the first night after surgery. Patients are required to start a regimen of physical exercise as soon as possible. Movement helps to prevent complications, like blood clots and pneumonia. One of the first exercises the physical therapist asks patients to do is to sit up and swing their legs off the side of the bed. This activity helps patients work back up to moving around after surgery.
After a few more days patients will walk around the intensive care unit (ICU) — with the help of your nurse or a walker — and will transition from a liquid–based diet for the duration of the hospital stay.
Benefits and Risks of an EPP
Benefits: An EPP slows the spread of mesothelioma, increasing your life expectancy and quality of life in the long term. A recent study reported that the median overall survival rate of patients treated with an EPP ranges from 9.4 to 27.5 months — the majority of medical studies have shown similar results.
Risks: The EPP is a complex procedure and, like any surgery, can cause complications. Common complications associated with the EPP include:
- Atrial fibrillation
- Mortality rate between 8 and 15 percent
An experienced doctor can, however, lower this risk with careful patient selection and better care after surgery; doctors working at experienced cancer centers have kept the mortality rate at 5 percent or lower.
For example, Brigham and Women’s Hospital, a top mesothelioma treatment center — and home of the EPP — has kept their in-house mortality rate at an amazing 3.4 percent. This is an incredible improvement over the 31 percent rate the EPP produced when it was first used to treat mesothelioma in the 1970s.