Extrapleural Pneumonectomy

Extrapleural pneumonectomy (EPP) is a surgical procedure that involves the removal of the lung along with its coverings and the associated coverings of the heart and diaphragm. Of all treatment approaches attempted, extrapleural pneumonectomy has been most consistently associated with long-term disease-free survival and has provided for the greatest amount of cytoreduction. Also, with the lung removed, a higher amount of radiation can be delivered.

EPP Procedure - Once the patient is under complete general anesthesia, an incision will be made extending from below the shoulder blade, around the side along the curvature of the ribs to the front of the chest on the side of the diseased lung (thoracotomy). The surgeon also may remove the sixth rib to help expose the lung and to obtain enough working space.

Next, the surgeon will collapse the diseased lung and tie off its major blood vessels. The lung's main bronchial tube (air tube) will be clamped and cut and the lung removed. The cut end of the bronchial tube either is closed with staples or tied off with sutures (stitches).

Next, the pleura will be carefully removed from the chest wall. Parts of the pericardium and diaphragm will be cut away on the affected side and replaced with patches made of Gore-Tex, a safe, synthetic material. After confirming that the closed end of the bronchial tube is not leaking air, the surgeon will close the chest incision with sutures, leaving a temporary drain in the chest cavity.

After surgery, the patient will be taken to the surgical intensive care unit (ICU). For the first 24 hours, a respirator may assist breathing, although many patients do not require it, and a chest drainage tube will remain in place. Once considered stable, usually within a few days, the patient will be transferred to a regular hospital room. Patients will be hospitalized between one and two weeks. All patients receive an epidural to control their pain.