Overview
Pleurectomy/decortication (P/D) is a surgical procedure that removes the pleural lining (the membrane surrounding the lungs) and any visible tumor. Unlike extrapleural pneumonectomy, P/D preserves the lung itself. This lung-sparing approach has become increasingly popular as it offers a balance between tumor removal and quality of life preservation.
Who May Be a Candidate
- Early-stage pleural mesothelioma (stages 1-2)
- Epithelioid cell type (most responsive)
- Good overall health and lung function
- No significant tumor invasion into chest wall
- Patients who want to preserve lung function
How It Works
The surgeon removes the parietal pleura (outer lining) and visceral pleura (lining on the lung surface), along with all visible tumor tissue. The diaphragm and pericardium may also be removed and reconstructed if involved.
Procedure Steps
- General anesthesia administered
- Incision made along the side of the chest (thoracotomy)
- Parietal pleura peeled away from chest wall
- Visceral pleura stripped from lung surface
- All visible tumor removed
- Diaphragm/pericardium reconstructed if needed
- Chest tubes placed for drainage
Benefits
- Preserves the lung, maintaining respiratory function
- Lower mortality risk than EPP (1-4% vs 4-10%)
- Shorter hospital stay and faster recovery
- Better quality of life after surgery
- Can be combined with heated chemotherapy (HIPEC)
Risks & Side Effects
- Air leaks from the lung surface
- Bleeding
- Infection
- Fluid accumulation
- Cancer recurrence (higher local recurrence than EPP)
- Respiratory complications
Recovery
Hospital stay is typically 5-10 days. Most patients return to normal activities within 4-6 weeks. Physical therapy helps restore lung function. Pain management is important during the initial recovery period.
Expected Outcomes
Studies show median survival of 16-31 months for P/D patients. Combined with chemotherapy and radiation, some patients live significantly longer. The lung-sparing nature allows patients to maintain better quality of life.
Finding Treatment
This procedure is typically performed at specialized mesothelioma treatment centers with experienced surgical teams. Consulting with a mesothelioma specialist is the first step in determining if this treatment is appropriate for your situation.