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New Study On EPP Finds Higher Risks

With the debate regarding the use of extrapleural pneumonectomy as a viable surgical treatment for patients suffering from malignant pleural mesothelioma, a recently conducted study is sure to add fuel to the fire. The study was the result of a collaboration between thoracic surgeons from UCLA and Stanford University, biostatisticians from Duke University and cardiothoracic surgeons from the University of Washington and the University of Chicago. The group reviewed retrospective data gleaned from the Society of Thoracic Surgeons0General Thoracic Database, pulling information from 225 mesothelioma patients who had undergone either extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D).

EPP has come under recent fire as a result of the invasiveness of the procedure. Though both procedures remove the pleural lining in a mesothelioma patient, EPP goes further and also removes the lung that is nearest to the tumor, as well as the diaphragm.  Though some mesothelioma surgeons believe that EPP offers patients the longest survival rates, others feel that the surgical trauma to the patient is too great, and there have been studies conducted that have borne out this concern.

The recent study, which was published in the Journal of Thoracic and Cardiovascular Surgery, found that EPP had a high risk of several problems. According to author Bryan Burt, MD, “Major morbidity was greater after extrapleural pneumonectomy, including acute respiratory distress syndrome … reintubation … unexpected reoperation… and sepsis… as was mortality…”

Broken down, the study found that 130 of the patients had the less-invasive P/D procedure, with the other 95 undergoing EPP. The surgeries were conducted in five different centers, three of which performed higher numbers of P/D and two of which performed higher numbers of EPP. The patients that were included in the study were similar in terms of severity of disease and other characteristics, though the researchers did find that patients who had undergone EPP had a tendency to have lower ages and a greater likelihood of having undergone chemotherapeutic treatment.

Determining the most appropriate treatment approach for a particular patient is one of the most difficult, yet most important aspects of mesothelioma treatment, so studies like this one that provide indications of the best outcomes for individual patients are extremely valuable. Though the study found that EPP was “an independent predictor of major morbidity or mortality,” the authors also indicated that there might be other factors in the surgical outcomes that needed to be studied further.

Terri Oppenheimer

Terri Oppenheimer is an independent writer, editor and proofreader. She graduated from the College of William and Mary with a degree in English. Her dreams of a writing career were diverted by a need to pay her bills. She spent a few years providing copy for a major retailer, then landed a lucrative career in advertising sales. With college bills for all three of her kids paid, she left corporate America for a return to her original goal of writing. She specializes in providing content for websites and finds tremendous enjoyment in the things she learns while doing her research. Her specific areas of interest include health and fitness, medical research, and the law.

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