Extrapleural pneumonectomy for pleural malignancies.

Although originally performed on patients with refractory tuberculosis and malignant pleural mesothelioma, extrapleural pneumonectomy may be used to treat patients with pleural dissemination of other malignancies, including thymoma and NSCLC. Patients who present with stage IV NSCLC caused by malignant pleural effusion may be considered for EPP following induction chemotherapy if they demonstrate no mediastinal nodal or distant metastases and have adequate cardiopulmonary reserve. EPP for NSCLC should be performed by experienced teams at experienced centers to minimize the morbidity and mortality associated with this radical procedure. Additional prospective studies are needed to better characterize the role of EPP in the multimodality treatment of patients with pleural dissemination of malignancy, including NSCLC.