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New Approach May Improve Safety of Controversial Mesothelioma Surgery

28185453_surgerymesotheliomaDoctors in Italy say they have found a way to perform a radical mesothelioma surgery called extrapleural pneumonectomy in a less-invasive way, potentially conferring many of the benefits with fewer risks.

The team performed the new surgical technique at an Italian University hospital on a patient with early-stage malignant pleural mesothelioma.

Radical Surgery for Pleural Mesothelioma

Extrapleural pneumonectomy (EPP) is a large and traumatic operation, involving the removal of the pleural mesothelioma tumor, the entire pleural membrane where the tumor grows, the nearest lung, lymph nodes, the diaphragm, and the pericardium which surrounds the heart. The diaphragm and pericardium are then reconstructed.

EPP is typically performed by making a large incision in the chest and separating the rib cage to expose the thoracic cavity. The surgery may be preceded or followed by chemotherapy and/or radiotherapy.

While some studies have shown a survival advantage with EPP, others have found that the high risk of death and complications (higher than 60 percent) from this type of mesothelioma surgery, outweigh the potential benefits.

A Safer Approach to EPP?

In an article published in the journal Innovations, a team of Italian thoracic surgeons explain their novel less-invasive technique for performing EPP surgery on mesothelioma patients without spreading the ribs.

“Our approach is unique and differed from the previously reported cases because we used one skin incision and two small intercostal incisions with videothoracoscopic viewing without rib spreading,” explains lead author Dr. Francesco Paolo Caronia with the Mediterranean Cancer Institute.

The ports inserted between the ribs make it possible for surgeons to perform the same operation without the pain and physical trauma caused by separating the rib cage.

Mesothelioma Patient Doing Well After Surgery

Following the modified mesothelioma surgery, the patient underwent three cycles of chemotherapy and had radiation.  Not only did the patient survive the EPP surgery, but eleven months later, his doctors report no recurrence of his cancer.

While some of the world’s top mesothelioma doctors still use the standard EPP approach for mesothelioma treatment, others believe that it is too risky and should be abandoned.

Mesothelioma surgeons in this camp advocate instead for pleurectomy/decortication (PD), which removes many of the same tissues but leaves the lung in place.


Caronia, FP, “Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma: A Novel Mini-Invasive Technique”, December 6, 2016, Innovations, ePub ahead of print

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