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Doctors are currently debating which surgery — the extrapleural pneumonectomy (EPP) or the lung-sparing pleurectomy with decortication (P/D) — is the best treatment for patients with pleural mesothelioma. Most doctors agree that the best procedure depends on a patient’s individual diagnosis.

If you’ve been diagnosed with pleural mesothelioma, you have two main options for surgery: an EPP, or a P/D.

Key Issues

Survival Rates: The EPP used to have substantially better survival rates than the P/D. Some believe the EPP has a better chance at improving survival because it removes more affected tissue. But the P/D has been improved over the years, so survival rates are similar between the two procedures.

Quality of Life: Some surgeons argue that the EPP is too radical, negatively affecting quality of life when a P/D would have been an acceptable procedure. Patients who have a lung-sparing P/D generally have a better quality of life.

Mortality Rates: The mortality rates involved with each surgery isn’t pointed out much in the pleural mesothelioma surgery debate. The EPP used to have higher mortality rates, but over time surgeons improved their technique, making the EPP safer.

Talk to someone on our Patient Help Team to learn more about these surgeries and to find treatment near you.

The Crux of the Debate

Though not officially, two world-renowned surgeons, Dr. David Sugarbaker and Dr. Robert Cameron, each represent opposing sides of the debate.

Representing one side is Dr. Sugarbaker, developer of the EPP, a procedure doctors use to remove the lung and nearby tissues affected by mesothelioma. Representing the other side of the debate is Dr. Cameron, developer of the P/D. Instead of removing the entire lung, doctors use the P/D to remove the lining of the diseased lung, and any surrounding tissues affected by tumor growth. Though each surgery approaches treatment differently, the goal of each is the same: to remove mesothelioma from the patient’s body.

Both doctors developed each surgery based on their respective medical philosophy. Dr. Sugarbaker believes that surgeons should do what they can to remove mesothelioma, and prevent it from returning — even if they have to remove the entire lung. Dr. Cameron’s goal, on the other hand, prefers to remove as much mesothelioma as possible without substantially reducing a patient’s quality of life.

Risks and Benefits Comparison

Each surgery has risks and benefits, the impact of which varies depending on a patient’s mesothelioma stage and cell type.

Benefits of an EPP

  • Better chance of removing all cancer.
  • Less chance of cancer recurring locally.
  • Standardized procedure.


Benefits of a P/D

  • Less post-surgery mortalities.
  • Lung-sparing.
  • Better post-surgery quality of life.


Risks of an EPP

  • Loss of lung
  • Post-surgery quality of life is lessened.
  • Cancer may recur at distant sites.


Risks of a P/D

  • Higher risk of cancer recurring locally.
  • Procedure is not standardized.

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Survival Rates After Surgery

According to several medical studies, both surgeries have produced similar survival rates. The largest of these studies — carried out by renowned mesothelioma surgeon Dr. Raja Flores and a team of specialists — compared the surgical results of 663 patients who received treatment between 1990 and 2006. The study concluded that patients who had a P/D experienced a slightly better survival rate — 23 months – compared to patients who had an EPP – 19 months.

However, Dr. Flores noted that survival rates depend on a variety of factors, like the cell type and cancer stage of a mesothelioma tumor, rather than on the surgery itself.

Another study — carried out by a team of medical researchers in Zurich, Switzerland — concluded the overall difference in survival rates produced by either surgery is not clearly significant. Much like the study conducted by Dr. Flores, these researchers reported the tumor’s cell type, and the quality of treatment received by the patient, play a more important role than the type of surgery.

Which is the Right Choice?

The right choice doesn’t depend on which procedure is the best overall. Whether or not a surgery — or any treatment — is suitable for you depends on your diagnosis, and how it fits into the treatment plan your doctor creates for you. Additionally, the International Mesothelioma Interest Group (iMiG) — a network of doctors and researchers working to find a cure for mesothelioma — met in 2012, and concluded the following about the EPP vs. P/D debate:

  • Both surgeries are valid, because their goal is to remove mesothelioma completely
  • To be truly effective, doctors should combine each surgery with chemotherapy or radiation therapy, as part of a multimodal therapy
  • A patient’s choice of surgery should depend on the mesothelioma’s cancer stage, the experience of their surgeon, and the track record of the treatment center where they have the procedure.


If you’d like to learn more about your treatment options, or would like to find an experienced doctor, speak to a member of our Patient Help Team. We’ll review your diagnosis, help you find financial aid to pay for treatment, and get you connected to an experienced doctor — for free. Request a call from a member of our Patient Help Team today, and get started on improving your prognosis.

You can also learn more about mesothelioma, your treatment options, and what you can do to improve your prognosis in our free, informational guide. Order your free copy of our comprehensive guide today