Although most commonly associated with surgery for malignant pleural mesothelioma, extrapleural pneumonectomy (EPP) may be used to treat patients with pleural dissemination of other malignancies. Patients who present with stage IV nonsmall cell lung cancer (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. With careful preoperative evaluation and perioperative care, the rates of complication and/or death are acceptable. Nevertheless, EPP for NSCLC should be performed by experienced teams at experienced centers to minimize morbidity and mortality.