Articles Posted in P/D vs EPP

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For over a decade, Los Angeles Mesothelioma Oncologist Surgeon, Dr. Robert Cameron, who serves as the director of UCLA’s Mesothelioma Comprehensive Research Program, and the Chief of Thoracic Surgery at the West Los Angeles Veterans Administration Hospital, has been one of the United States’ most outspoken critics of Extra-Pleural Pneumonectomy (EPP).

The EPP procedure requires the removal of the lung lining, part of the membrane covering the heart and diaphragm, and the entire lung of the mesothelioma patient. Often times the lining is replaced with a synthetic lining.

Instead, Dr. Cameron has advocated that surgeons treat mesothelioma, but save the mesothelioma’s patient’s lung, using the less radical Pleurectomy/Decortication (P/D) surgery.



Dr. Cameron has performed P/D on mesothelioma patients numerous times over the last 20 years, and is considered one of the world’s leading experts in the surgery.
P/D requires only partial removal of the lining surrounding the lung, and at times, partial removal of the lining surrounding the diaphragm.

A new report, appearing the April 2012 issue of the Journal of Thoracic Oncology, supports his position.

According to the report, issued by the International Association of Lung Cancer, pleurectomy/decortication is both safer and more effective measurably when compared to extrapleural pnemonectomy (EPP). The results of the study add fire to ongoing debate as to how to treat mesothelioma patients, as EPP has been accepted by many oncologist surgeons as the standard of care to treat the disease.

Mesothelioma Attorney Michael Mandelbrot, of the Asbestos Legal Center in San Francisco, whose firm donates money to mesothelioma medical research, appreciated the results of the study, “In the ongoing battle against mesothelioma, this study arms mesothelioma patients with more vital data to discuss and consider in choosing their treatment plan.”

The International Lung Cancer Association study, conducted by Dr. Lang-Lazdunski of Kings College London-Division of Cancer Studies, had a population 76 patients that were followed for eight years, from 2004 to 2011. Fifty-four P/D patients were compared to twenty-two EPP patients.

The P/D groups 30-day mortality rate was 0, while the EPP patients suffered a 4.5 percent 30-day mortality rate. Moreover, 68 percent of EPP patients suffered post surgery complications, as compared to 27 percent of the P/D patients.
Most importantly, the median, two-year, and five years survival rate was higher for P/D patients as compared to EPP patients.

The study’s author no longer performs EPP in mesothelioma patients, and now advocates P/D becoming the standard of care surgical procedure offered to pleural mesothelioma patients, in multi-modal therapy.

The International Association of Lung Cancer study found that patients who underwent EPP suffered a higher mortality and morbidity rate than P/D. Putting it another way, those patients who underwent P/D had a higher survival rate.

As a result of the study, Michael Wyenat, M.D. University of Colorado professor and thoracic surgeon, authored an editorial that appears in the Journal of Thoracic Oncology, with the study. Dr. Weyant writes: “The results of the current study provide additional data that should lead us to consider P/D in all trials of treatment for MPM, (malignant pleural mesothelioma Continue reading