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EPP vs P/D: Conclusions are Reached in the Ongoing Debate

Lung images

MD Anderson Cancer Center conducted a retrospective study comparing surgical outcomes and long-term survival of mesothelioma patients who underwent either the extra-pleural pneumonectomy (EPP) or the pleurectomy/decortication (P/D) over the last two decades.

Although the study concluded that both the EPP and P/D had comparable long term oncological outcomes, it found that the P/D was better tolerated and had much lower perioperative mortality rates. The EPP was formally the surgery of choice until patients started choosing the P/D more in recent years.

The EPP is considered the more aggressive surgery since it involves the entire removal of the diseased lung. Whereas the P/D, the procedure pioneered by renowned UCLA cardiothoracic surgeon, Dr. Robert Cameron is the more conservative option targeting the removal of just the affected pleural lining and any visible tumors elsewhere in the thoracic cavity while leaving the lungs intact. Dr. Cameron is recognized as the innovator and earliest proponent of the lung-sparing P/D which he has perfected over the past 20 years.

These two surgical options have long been the subject of ongoing debate in choosing the optimal treatment for mesothelioma patients. The consensus has shown that there is no significant benefit in terms of survival by choosing the riskier EPP when the safer P/D is better tolerated. Ultimately, whichever surgical option is chosen, the best results are achieved when surgery is part of a multi-modal treatment plan, which may also include radiation, immunotherapy and/or chemotherapy.