Clapper, Patti, Schweizer and Mason

Extra-Pleural Pneumonectomy (EPP) is a radical surgery used to combat mesothelioma in which an entire lung, sometimes with the surrounding pleura and parts of the diaphragm, is completely removed.  The surgery is risky, lengthy, and costly but up until recently doctors had thought it useful in some mesothelioma cases that would not respond well to other forms of treatment.

However, several new studies have come to light in the last few months that suggest that the risks of EPP can outweigh any benefits that mesothelioma sufferers might gain from the procedure.

The Mesothelioma and Radical Surgery (MARS) randomized feasibility study was a multi-part, multipurpose trial that examined not only survival rates but quality of life after pneumonectomy in mesothelioma patients.  The goal of the study was to assess the individual outcome of this radical surgery and systematically weigh the pros with the cons.

The MARS study encompassed patients 18 years and older from 12 hospitals in the United Kingdom who were suffering from confirmed cases of mesothelioma.  All of the patients underwent platinum-based chemotherapy before the randomization took place in order to create a stable baseline from which researchers could draw conclusions.

The patients were then grouped into two units: one unit would undergo EPP followed by radiation therapy; and a second which would undergo EPP but not the radiation. 

The study took place between October 1, 2005, and November 3, 2008.  Fifty patients were culled from a field of 112 and took place in the trial. 

Several of the participants backed out before surgery, either due to personal choices or because they were not healthy enough to proceed.  Three patients died during or shortly after the surgery, and 16 survived the surgery bringing the overall risk factor of dying to nearly 1 in one hundred.

In comparison, 26 patients were placed in a group that did not undergo EPP. 

After the surgery, patients were assessed as to their quality of life.  The assessment showed lower quality of life scores in the EPP group and 10 patients had serious adverse reactions (compared to 2 in the non-EPP group.)

Doctors and researchers alike were shocked by the high death rate in this trial and decided that it would not be humane to attempt a similar trial with a larger population. 

When the data was collected, recorded, and analyzed, researchers came to the conclusion that because the risk of death was so high and the quality of life scores so comparatively low in addition to the fact that both groups of patients maintained an average 14 month survival that  EPP actually did more harm than good. 

On the flip side, Dr. Sugarbaker, a leading thoracic surgeon at Brigham and Women's Hospital in Boston, MA, who specializes in performing EPP’s, believes that the risk of complications and death due to surgery can be greatly reduced by good patient selection as well as ensuring only surgeons trained for EPP perform the procedure.   For more on EPP, read our article in the treatment section of our website. 

Mesothelioma is a killer disease.  It strikes nearly 3,000 people in the United States every year.  Though mesothelioma is preventable by avoiding all exposure to asbestos, once diagnosed with the disease patients will inevitably succumb.  That is the main reason why so many are willing to undertake such drastic measures as EPP.  However, as the MARS study illustrates, not all of these measures produces results that are worth the risk.