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Key takeaways: One of the treatments for mesothelioma (usually used in conjunction with other
therapies, like chemotherapy or radiation therapy) is surgery. This means that the spread of
cancer is resectable, or able to be entirely removed. Extended pleurectomy/decortication is the
most popular surgery: it includes a removal of the pleural tissues and removing only of affected
areas in the chest/lungs. An extrapleural pneumonectomy might be used for more advanced
stages of mesothelioma, as it includes the entire removal of lungs/pleura. Importantly, both
techniques have been found more effective when used in conjunction with other therapies,
when treating mesothelioma, especially in preventing the remission of mesothelioma.

Mesothelioma surgery

Extended Pleurectomy/Decortication (eP/D)

While this isn’t the most radical surgical approach, eP/D is a viable treatment option, especially
for cases of pleural mesothelioma that haven’t infiltrated the lungs. eP/D seeks to preserve lung
tissue: first, the pleurectomy procedure removes the pleura, or the tissue surrounding the lungs.
This is where pleural mesothelioma originates. Next, the decortication phase of treatment serves
like a spot-treatment for abnormal growths: instead of removing the entire affected location,
doctors will remove any abnormal areas of growth. This is usually on the lungs, considering their
proximity to the pleural tissues, but can also be anywhere in the chest cavity (like the
mediastinum, diaphragm, pericardial tissues, etc.)

Some retrospective analysis studies have found the relatively less invasive eP/D procedure to be
more effective than other surgeries; this could be because of the age of mesothelioma patients
and their ability to tolerate invasive surgeries.

Extrapleural Pneumonectomy for Treating Mesothelioma(EPP)

Extrapleural pneumonectomy (EPP) is a course of treatment that seeks to remove and replace.
Depending on the extent of metastasis (or spread), stage of mesothelioma, and the overall health
of the patient prior to treatment, EPP is an option. Oftentimes, it’s a technique used with different
treatments to ensure the cancer a.) does not spread beyond what is resectable (what is able to be
removed with surgery, and b.) isn’t “hiding” beyond detection (i.e., in other tissues, wasn’t
removed or killed in its entirety). As compared to other surgery-based techniques, like the
aforementioned eP/D, EPP is a radical removal and replacement. EPP seeks to remove entire
organs that have been affected: sometimes, entire lungs or mesothelial tissues will be removed
and replaced with artificial renderings.

The overall median survival rate post-EPP is 12-20 months, which is a significant improvement
from traditional mesothelioma projections of survival, which is around or less than 12 months.
Self-attributed quality of life rates increased after the EPP surgery; this could because an EPP
alleviates the discomfort and pressure of mesothelioma. Importantly, though, the eP/D procedure
is more widely recognized and used, given it doesn’t take the removal, generation, and
replacement of entire organs.

Trimodality Therapy for Treating Mesothelioma(TMT)

As previously mentioned, using resectable (surgical) techniques with non-surgical therapies (like
radiotherapy, chemotherapy, etc.) has proven more effective than either technique on their own.
This approach is formally called trimodality therapy (TMT), and its effectiveness is
well-documented: “Multimodality strategies, proposing surgery, chemotherapy, and radiotherapy
combined in various orders, are shown to improve survival with reported median survivals
between 17 and 35 months and 5-year survival of 15% to 20% in different series
[17,28,29,30,31],” (Mangiameli et al.). Because TMT depends on patient-dependent variables,
like the extent of the cancer, where it has spread, etc., the order of TMT is subject to change. For
example, one patient might receive chemotherapy then undergo eP/D; another patient might
undergo EPP then radiotherapy. The utility of TMT is its ability to cater to and and support
different cases of mesothelioma.

If you or a loved one has been diagnosed with mesothelioma, please call The Halpern Law Firm
at (800)-505-6000. We are here to help you navigate the legal process of filing a claim to receive
compensation for your cancer diagnosis. We help mesothelioma victims and their families in

A Systematic Review of Extrapleural Pneumonectomy for Malignant Pleural
Mesothelioma—ScienceDirect. (n.d.). Retrieved February 5, 2024, from

Cao, C., Tian, D., Park, J., Allan, J., Pataky, K. A., & Yan, T. D. (2014). A systematic review
and meta-analysis of surgical treatments for malignant pleural mesothelioma. Lung
Cancer, 83(2), 240–245. https://doi.org/10.1016/j.lungcan.2013.11.026

Mangiameli, G., Bottoni, E., Voulaz, E., Cariboni, U., Testori, A., Crepaldi, A., Giudici, V.
M., Morenghi, E., & Alloisio, M. (2021). Extended Pleurectomy/Decortication for
Malignant Pleural Mesothelioma: Humanitas’s Experience. Journal of Clinical
Medicine, 10(21), 4968. https://doi.org/10.3390/jcm10214968

Written By Carina Filemyr

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Page Reviewed and Edited by
Dave Halpern, Mesothelioma Attorney

Dave Halpern is a Pennsylvania and New Jersey mesothelioma attorney with over 30 years of experience. He has investigated hundreds of cases and won numerous multimillion dollar settlements and verdicts for asbestos victims. Dave prides himself on working tirelessly to help his clients in their time of need. 

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