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Extrapleural pneumonectomy or pleurectomy: removing the lung or keeping it | CION Cancer Clinics
Extrapleural pneumonectomy (EPP) removes the whole lung on one side together with the chest lining. Pleurectomy and decortication (P/D) removes the lining but keeps the lung. Both are major operations for pleural mesothelioma, offered only to a small group of fit people. EPP is done far less often now. This page compares the two, explains who neither suits and lists what to ask your surgeon. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is the difference between EPP and pleurectomy?
- How do the two operations compare?
- What does each operation mean for your body?
- How does the surgical team choose between them?
- Why is EPP done so much less often now?
- What do families often assume when comparing them?
- What should you ask before agreeing to either operation?
- Common questions about EPP and pleurectomy
The short answer
What is the difference between EPP and pleurectomy?
Extrapleural pneumonectomy, or EPP, removes the whole lung on one side along with the chest lining. Pleurectomy and decortication, or P/D, removes the lining but keeps the lung. Both are major operations for pleural mesothelioma, and many specialist centres now prefer P/D when they operate at all.
Why there are two approaches
Mesothelioma grows as a sheet over the lining of the lung and chest wall. Surgeons once thought the surest way to clear it was to take the lung out with it. Later, many came to feel that keeping the lung could remove a similar amount of visible cancer with fewer serious problems.
What both have in common
Neither removes every cancer cell. Both need a long hospital stay and months of recovery. Both are offered only to a small group of people who are fit and whose cancer is limited to one side of the chest. And both are usually part of a wider plan with chemotherapy, immunotherapy or radiotherapy.
Why the name matters when you talk to the team
Surgeons use several names and short forms, and families often mix them up. EPP always means the lung is removed. P/D, extended P/D and partial pleurectomy all keep the lung, but differ in how much else is taken. When an operation is mentioned, ask the surgeon to write down its full name and whether the lung stays. It makes later conversations, and any second opinion, far clearer.
This comparison is general. It cannot tell you which operation, if either, suits you. Your treating team makes that recommendation with you.Side by side
How do the two operations compare?
Extrapleural pneumonectomy (EPP)
Pleurectomy and decortication (P/D)
Removes the lung, lining, part of the diaphragm and heart sac
Removes the lining, sometimes part of the diaphragm and heart sac
You live with one lung afterwards
Both lungs stay
Higher risk of serious problems around the operation
Lower risk, though still a major operation
Radiotherapy to the whole side of the chest is possible afterwards
Radiotherapy is harder because the lung is still there
Done far less often today
The more common choice in centres that still operate
In more detail
What does each operation mean for your body?
After EPP
The space where the lung was slowly fills with fluid and scar tissue. Your remaining lung does all the breathing, so activity is more limited and climbing stairs can feel hard for a long time.
Problems the team watches for
- A leak where the main airway was closed
- Infection in the empty space
- An irregular heartbeat
After P/D
The lung stays, and if it was squashed by a thick rind it may open out and breathe better. The raw lung surface often leaks air for some time, so the chest drains stay in longer.
Problems the team watches for
- An air leak that is slow to settle
- Bleeding from the lung surface
- Chest infection
Not sure whether this applies to you?
Ask an oncologistMaking the choice
How does the surgical team choose between them?
Where the cancer has spread
Scans show whether the cancer is thin or bulky, and whether it has grown into the lung itself, the breathing muscle or the heart sac. Bulky disease growing into the lung may make P/D difficult.
How much lung reserve you have
Breathing tests estimate whether you could manage on one lung. Many people could not, which rules out EPP even when it might otherwise be considered.
Heart and general fitness
Both operations strain the heart. A heart scan and a check of how active you are day to day help judge whether recovery is realistic.
The team's own experience
Each operation needs a specialist team. Ask which one they do more often and why they are suggesting it for you.
The evidence
Why is EPP done so much less often now?
A UK trial comparing EPP with no major surgery raised serious concerns. People who had EPP did not do better on average, and some did worse. Since then many specialist centres have moved away from removing the lung, and prefer P/D if they operate.
P/D has questions too
A later large UK trial looked at extended P/D added to chemotherapy. It did not help people live longer on average, and it caused more serious problems than chemotherapy alone. Some surgeons feel carefully chosen people may still benefit. Others feel surgery should mostly be offered within studies.
Who neither operation suits
Neither is usually offered when the cancer is the sarcomatoid cell type, when it has spread to lymph nodes in the middle of the chest or to the other side, or when heart or lung tests show a major operation would be too dangerous. Neither is a quick fix for breathlessness from fluid, which smaller procedures handle better.
The trials describe groups of people, not you. Ask your surgeon how the evidence applies to your own scans and fitness.Commonly believed
What do families often assume when comparing them?
"Taking the whole lung out removes more cancer, so it must be safer."
Removing more tissue does not mean removing all the cancer, and it adds risk. Trials have not shown that the larger operation helps people do better.
"You cannot live a normal life with one lung."
Some people do manage daily life with one lung, but only if the remaining lung is strong. That is exactly what the breathing tests check before EPP is considered.
"If the surgeon suggests P/D, they are holding back."
Choosing to keep the lung reflects how thinking has changed, not a lack of effort. The aim of both operations is the same: to remove all visible cancer.
"Whichever operation is chosen, the hard part is over once we leave hospital."
Recovery at home takes months after either operation, and further treatment usually follows. Families who plan for help with daily tasks, follow-up visits and travel cope far better than those who expect a quick return to normal.
Take this list with you
What should you ask before agreeing to either operation?
- Which operation are you proposing, and why that one for me?
- What would treatment look like without surgery?
- How often does your team do this operation?
- What are the most likely problems afterwards?
- How long will I be in intensive care and in hospital?
- What treatment will follow, and when?
- Is this being offered as part of a study?
- Can we get a second opinion before deciding?
Questions we are asked
Common questions about EPP and pleurectomy
Which operation removes more of the cancer?
EPP removes more tissue, because the lung goes too. In practice, both aim to remove all the cancer that can be seen, and neither removes every cell. What matters more is whether the operation suits your disease and fitness, which your surgeon will explain.
Is EPP still done anywhere?
It is still done in a few specialist centres for very carefully chosen people, but far less often than before. If EPP is suggested, it is reasonable to ask why the team prefers it over keeping the lung in your case, and to seek a second opinion.
Can P/D be changed to EPP during the operation?
Sometimes a surgeon finds the cancer has grown deep into the lung and cannot be peeled away. Your consent form should say what the surgeon may do in that situation. Talk this through before the day, so you and your family know what could happen.
Which has the longer recovery?
Both take months. After EPP, breathing is permanently limited to one lung, so the recovery of stamina is often slower and less complete. After P/D, air leaks can keep you in hospital longer at first, but the lung remains for later.
Will I need oxygen at home afterwards?
Some people do, particularly early on or after EPP, and many do not. It depends on how well your remaining lung tissue works. The team will check your oxygen levels before you go home and arrange oxygen if you need it.
Why would radiotherapy be given after surgery?
To treat cells that may remain in the chest. It is easier to aim radiotherapy at the whole side of the chest once the lung is gone, which is one reason EPP was once paired with it. After P/D the lung is in the way, so radiotherapy is planned differently.
Is either operation a replacement for chemotherapy?
No. For most people, medicines such as chemotherapy or immunotherapy are the main treatment for mesothelioma, whether or not surgery is done. Surgery, when offered, is usually one part of a plan. Your oncologist will explain the order of treatments.
What if neither operation is offered?
That is the most common situation, and it does not mean nothing can be done. Treatment with medicines, radiotherapy for pain, and procedures to drain or stop fluid can all help. Ask the team to explain the plan they are recommending instead.
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Sources
- National Cancer Institute — Malignant Mesothelioma Treatment (PDQ), patient version
- NHS — Mesothelioma: treatment
- Cancer Research UK — Mesothelioma
- American Cancer Society — Malignant Mesothelioma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Pleurectomy and Decortication ExplainedA closer look at the operation that keeps the lungWho Is a Candidate for Mesothelioma SurgeryThe tests and factors behind the decisionSurgery for Mesothelioma: What Is PossibleAll the surgical options, including the smaller onesChoosing a Surgeon and a CentreWhat to ask about a team's experience
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