Select Mesothelioma Patients Still Benefit from EPP Surgery

Treatment & Doctors
Reading Time: 4 mins
Publication Date: 04/17/2017
Fact Checked
Our fact-checking process begins with a thorough review of all sources to ensure they are high quality. Then we cross-check the facts with original medical or scientific reports published by those sources, or we validate the facts with reputable news organizations, medical and scientific experts and other health experts. Each page includes all sources for full transparency.
Reviewed is the nation’s most trusted mesothelioma resource

The Mesothelioma Center at has provided patients and their loved ones the most updated and reliable information on mesothelioma and asbestos exposure since 2006.

Our team of Patient Advocates includes a medical doctor, a registered nurse, health services administrators, veterans, VA-accredited Claims Agents, an oncology patient navigator and hospice care expert. Their combined expertise means we help any mesothelioma patient or loved one through every step of their cancer journey.

More than 30 contributors, including mesothelioma doctors, survivors, health care professionals and other experts, have peer-reviewed our website and written unique research-driven articles to ensure you get the highest-quality medical and health information.

About The Mesothelioma Center at

  • Assisting mesothelioma patients and their loved ones since 2006.
  • Helps more than 50% of mesothelioma patients diagnosed annually in the U.S.
  • A+ rating from the Better Business Bureau.
  • 5-star reviewed mesothelioma and support organization.
Learn More About Us


"My family has only the highest compliment for the assistance and support that we received from The Mesothelioma Center. This is a staff of compassionate and knowledgeable individuals who respect what your family is experiencing and who go the extra mile to make an unfortunate diagnosis less stressful. Information and assistance were provided by The Mesothelioma Center at no cost to our family."
Mesothelioma patient’s daughter
  • Google Review Rating
  • BBB Review Rating

How to Cite’s Article


Povtak, T. (2022, December 16). Select Mesothelioma Patients Still Benefit from EPP Surgery. Retrieved February 1, 2023, from


Povtak, Tim. "Select Mesothelioma Patients Still Benefit from EPP Surgery.", 16 Dec 2022,


Povtak, Tim. "Select Mesothelioma Patients Still Benefit from EPP Surgery." Last modified December 16, 2022.

The controversial extrapleural pneumonectomy (EPP) surgery should remain a viable option for select patients with malignant mesothelioma, despite a growing reluctance today among thoracic surgeons to recommend the procedure.

When combined with intensity modulated radiation therapy (IMRT), the EPP still can benefit some patients and improve survival times significantly, according to a recent study at the Baylor Scott & White Medical Center in Temple, Texas.

The retrospective look at 18 patients who underwent the EPP/IMRT combination found an average, overall survival rate of 38.2 months and a median relapse-free survival of 24.4 months — well above the norm for this aggressive and incurable cancer.

“This form of treatment is not dead yet and should not be buried before it’s dead,” lead author radiation oncologist Dr. Sameer Jhavar told “Our research shows this is actually a very, very good combination for a select group of patients with this disease.”

Asia-Pacific Journal of Clinical Oncology recently published the report.

Other Mesothelioma Specialists Disagree with EPP

The results were in contrast to the opinions of several specialists who have moved away from performing the EPP in the treatment of pleural mesothelioma.

Dr. Tom Treasure at the University College London, for example, told in March that “the EPP can’t be justified anymore. One more of these is one too many.”

The EPP, which surgeons more extensively performed for mesothelioma a decade ago, involves removing the entire diseased lung, chest lining, major parts of the diaphragm, lining of the heart, lymph nodes and at least one rib.

It is one of the most extensive surgeries for any cancer.

The mesothelioma medical community once considered the EPP standard of care along with chemotherapy and radiation for pleural mesothelioma because it provided maximum resection of the disease.

However, many thoracic surgeons have cut back on the EPP because older patients often struggle coming back from such a life-changing surgery. The mortality and morbidity rates were higher than with a less aggressive surgery, meaning patients’ life expectancy was significantly shortened.

Pleurectomy/Decortication Surgery Gains Popularity

Many mesothelioma patients and their surgeons now turn to the pleurectomy/decortication (P/D) surgery, which leaves the lung intact and reduces recovery time.

“They are right, and not wrong, in saying the EPP is too much for many patients,” Jhavar said. “It all depends on the patient selection. In the right patient population, it can be done safely and effectively and provide survival hope. The key is selecting the right patients.”

The median age of the 18 patients in the Jhavar’s study was 65. They were among 104 patients with mesothelioma who were treated at the Baylor Scott & White Medical Center from 2005 to 2014.

In order to qualify for surgery, the researchers carefully screened the selected participants with extensive testing, including pulmonary function tests and a laparoscopy to ensure negative metastatic workup.

Impressive Mesothelioma Survival Rates with EPP

Postsurgery results were impressive. Patients didn’t experience fatal pulmonary toxicity, and results showed no toxicity recorded above grade III.

The two-, three- and five-year survival rates were 66 percent, 50 percent and 33 percent, respectively. These survival rates were among the best recorded using the combined EPP/IMRT treatment plan.

Earlier this year, cancer researchers at Kyoto University in Japan studied 21 pleural mesothelioma patients who underwent the EPP surgery and IMRT combination. The results of this study, published in Swedish medical journal Acta Oncologica, were not as impressive.

Researchers recorded a three-year survival rate of 37.5 percent and a median survival rate of 27 months after surgery. Three of the 21 participants were still alive five years after surgery.

Improved surgical techniques and more precise delivery of radiation have boosted the success of the EPP/IMRT combination. Patient selection has also improved.

Jhavar advises that only a small percentage of mesothelioma patients should be considered for the EPP surgery.

“This surgery may have fallen out of favor with some,” he said. “But it still should be considered. The surgeon selects these patients. In your eyes, an apple might be rotten, but in someone else’s eyes, you might still get the best out of that apple.”

open book icon vector illustration
Medically Reviewed by Top Mesothelioma Doctors
Free Mesothelioma Guide