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An extrapleural pneumonectomy (EPP) is a radical surgical operation that involves the complete removal of the affected lung along with parts of the surrounding pericardium, diaphragm muscle, and parietal pleura.
The operation is highly invasive and complex, so it is typically reserved for patients who have localized malignancy, no sign of lymph node spread, no sign of other metastases, and have overall adequate health measures for heart, lung, liver, and kidney functioning.[10] Primary goals include improving long-term survival chances and controlling the spread of malignancy, although some patients could be potentially cured by the operation.
To perform the procedure, first an incision is made along the back and side at the location of the sixth rib. The rib is partially removed, and the extrapleural tissue is dissected, with care taken not to puncture the pleural cavity. Part of the pericardium is excised and used to aid in the extraction of the pleural tissues. The lung is then removed, and the surgeon will seal the bronchial tube on the affected side with a surgical stapler. The pericardium is repaired using bovine tissues, and the surgeon will ensure that other major vessels and tissues are repaired to achieve hemostasis, meaning that bleeding is stopped. A diaphragmatic patch is placed to ensure proper functioning.[11],[12]
The entire procedure is quite extensive and requires the resources of a large, well-funded hospital facility and a team of experienced surgeons. Recovery requires at least two weeks of hospitalization.
Risks associated with an extrapleural pneumonectomy include[13]:
- Irregular heartbeat
- Required use of an intubation tube for 3 or more days
- Vocal cord paralysis
- Deep vein thrombosis
- Hemorrhage
- Accumulation of fluid on the heart
- Acute respiratory distress
- Cardiac arrest
- Heart failure
- Fluid in the lungs
- Renal failure
Despite these risks, the vast majority of patients survive the surgery. Since the operation began seeing recurring use in 1976, perioperative mortality has decreased from 31% to 3.4%.[14]
[10] https://thoracic.surgery.ucsf.edu/conditions–procedures/extrapleural-pneumonectomy.aspx
[11] https://mmcts.org/tutorial/1005
[12] https://www.ctsnet.org/article/extrapleural-pneumonectomy
[13] https://www.sciencedirect.com/science/article/pii/S0022522304003964
[14] https://www.optechtcs.com/article/S1522-2942(10)00135-2/fulltext
