Pleurectomy/Decortication for Mesothelioma

What Is Pleurectomy/Decortication (P/D)?

Pleurectomy/decortication (P/D) is a surgery for pleural mesothelioma, the most common type of mesothelioma. It removes the lining of the lung and visible tumors but leaves the lung itself in place. This can ease symptoms, improve breathing and help people live longer.

Key Facts About Mesothelioma Pleurectomy With Decortication

1. P/D is a two-step surgery: pleurectomy removes the lung lining, and decortication removes surface tumors.
2. The procedure takes 4 to 6 hours and is done under general anesthesia.
3. Most people stay in the hospital for 7 to 10 days, with full recovery taking several weeks or months.
4. P/D helps reduce chest pain, coughing and trouble breathing, improving quality of life.
5. It has been a recognized treatment for pleural mesothelioma for decades, offering a less aggressive option than extrapleural pneumonectomy (EPP), which removes a lung.
   

P/D is often combined with chemotherapy, radiation or immunotherapy to destroy any mesothelioma cells left behind. This multimodal approach can help extend survival and lower the risk of the cancer returning.

Because the lung is left in place, many people with mesothelioma can breathe more easily after surgery and recover with less impact on daily life. P/D may be a good option for those looking to manage symptoms while staying as active as possible.

Types of P/D for Mesothelioma

There are 2 main types of pleurectomy/decortication surgery for pleural mesothelioma. Both aim to remove as much cancer as possible while helping you keep your strength and lung function. The difference is in how much tissue is removed based on how far the cancer has spread.

P/D Surgery Options

• Extended P/D: An eP/D procedure removes the lung lining, the lining of the diaphragm and the sac around the heart.
  
• P/D: Removes the lung lining and visible tumors, but leaves other nearby tissues in place.

Doctors use imaging and other tests to see how far the cancer has spread and decide which surgery is right for you. Your surgeon will talk with you about your options, aiming to remove as much mesothelioma as possible while helping you feel better, breathe easier and live longer.

How Pleurectomy/Decortication Works

A thoracic surgeon performs pleurectomy/decortication in a hospital under general anesthesia. It’s an inpatient procedure, and most people stay in the hospital for several days to recover. In the first step, surgeons remove the pleural lining from the chest wall. In the second, they focus on tumors and affected tissue on the surface of the lung.

Pleural mesothelioma survivor Joe Barna credits P/D surgery for his success. He tells us, “I remember Dr. DaSilva going into surgery talking about my disease, in so many words saying, ‘We’re going to kick its ass.’ He just gave me such an incredibly positive feeling. My last checkup with him he told me, ‘You don’t even need to be here.’”

Step 1: Pleurectomy

To start the procedure, the surgical team positions you on your side. Your surgeon then makes a long incision along your back, called a thoracotomy, to open your chest cavity. This incision runs from near your spine down toward your lower ribs.

If mesothelioma has spread to the lower chest, a second incision may be needed. In some cases, the sixth rib is removed to create more space. Your surgeon removes your parietal pleura, the outer layer of the lung’s lining, along with any visible cancer on the chest wall lining, heart sac or diaphragm.

Step 2: Decortication

Once the pleurectomy is complete, your surgeon begins the second part of the procedure: removing visible mesothelioma tumors from the surface of your lung. In some cases, they gently scrape the lung to clear away any remaining cancer. When the cancer has been removed, the surgeon closes your incision with stitches.

“We’re finding that we’re able to remove all the tumor that’s visible,” Dr. Andrea Wolf, director of the New York Mesothelioma Program at Mount Sinai, tells us. “That’s why there’s been a shift toward doing this lung-sparing procedure more so than in decades past.”

Before finishing the surgery, the team works to seal blood vessels to prevent bleeding. Some surgeons may also use additional treatments during surgery. These include photodynamic therapy, heated chemotherapy solutions and experimental chemotherapy gels.

Pleurectomy/Decortication Surgery Preparation and Recovery

Before pleurectomy/decortication, your care team takes several important steps to get you ready for this mesothelioma surgery. These steps help doctors better understand your overall health and plan a safe and effective procedure. Knowing what to expect can help you feel more informed and in control.

How to Prepare for P/D Surgery

• Pre-Surgery tests and assessments: Before surgery, your doctor will order imaging scans, bloodwork and other tests to evaluate your health and make sure you’re ready for the procedure.
  
• Discussions with your surgical team: This is a good time to ask questions about the surgery, anesthesia or what recovery might look like.
  
• Adjustments to medications: Your doctor may recommend pausing or changing certain medications, especially blood thinners or drugs that affect healing.
  

Clear planning allows your medical team to perform surgery safely and address any concerns you may have ahead of time. Staying connected with your surgical team helps you feel supported every step of the way.

Recovery After Pleurectomy/Decortication

Most people stay in the hospital for about two weeks after pleurectomy/decortication. During this time, doctors monitor your progress, manage any complications and begin therapies to support breathing and healing. Nurses and therapists may also begin teaching you exercises to support your recovery from surgery.

Once you return home, recovery continues over the next several weeks. Your care team will give you clear instructions, help coordinate follow-up care and may recommend additional support such as pulmonary rehabilitation. Staying involved in your care and attending follow-up appointments can make a meaningful difference in how you heal.

Who Is Eligible for a Pleurectomy/Decortication (P/D)?

People in overall good health with an early-stage mesothelioma diagnosis may qualify for P/D. This lung-sparing procedure is most effective when the cancer is still confined to the chest, such as in stage 1 or 2 pleural mesothelioma. In these stages, surgery can often remove most or all visible tumor tissue.

Key Factors That Affect Eligibility for P/D Surgery

• Age: Younger adults often have better surgical outcomes due to stronger immune systems and fewer underlying conditions.
• Cancer stage: The earlier the stage, the more likely P/D will be an option. Later stages may require different therapies.
• Lung function: Since P/D aims to preserve the lung, good breathing capacity helps make surgery safer and more effective.
• Overall health: Conditions like heart disease or diabetes may increase surgical risks and affect eligibility.
• Tumor size and location: Doctors assess whether tumors can be safely removed without damaging critical tissues.

Not everyone diagnosed with mesothelioma will initially qualify for P/D surgery. But many people have discovered new options by getting second opinions and advocating for their care. Your doctor will carefully evaluate your overall health and cancer stage to determine if surgery is a good fit for you. If it’s not, they can help guide you to other mesothelioma treatment options tailored to your needs.

Kevin Hession

Verified Asbestos.com Survivor

Mesothelioma Survivor Talks Life After Decortication Surgery

Kevin Hession underwent decortication surgery to remove all visible tumors in January 2022, about 5 months after being diagnosed with pleural mesothelioma. Kevin spoke with The Mesothelioma Center to share his experiences while recovering from surgery and to explain some lasting effects from the procedure.

Kevin Hession

Verified Asbestos.com Survivor

Read Kevin’s Story

Benefits of Pleurectomy/Decortication for Mesothelioma Patients

P/D can help people with pleural mesothelioma live longer and breathe easier. Removing visible tumors while sparing the lung helps relieve symptoms and maintain lung function.

Doctors often recommend P/D when mesothelioma hasn’t invaded the lung itself. Research shows it offers positive outcomes with a low risk of serious complications.

Primary Advantages of P/D

• Easier recovery: People often recover more quickly than with more invasive surgeries.
• Extended survival: P/D can extend survival to around 20 months, especially when combined with other therapies.
• Fewer complications: The risk of serious problems or death during or after surgery is low at about 1% to 2%.
• High symptom relief rate: According to P/D pioneer Dr. Robert Cameron, P/D reduces pain and breathing problems in about 90% of cases.
• Lung preservation: Unlike extrapleural pneumonectomy, P/D leaves the lung intact, helping patients recover with better breathing.
  

Some clinical trials are testing ways to enhance results. For example, Dana-Farber is studying P/D with intensity modulated radiation therapy. A 2023 trial questioned whether surgery plus chemo offers better outcomes than chemo alone. Patients should explore all mesothelioma treatment options with their mesothelioma care team, and ask whether P/D is right for them.

Risks and Complications of Pleurectomy/Decortication

Common risks of P/D for mesothelioma include infection, bleeding, fatigue and breathing problems. Serious complications are rare, but every surgery comes with some risk. Knowing what to expect can help you talk with your doctor and feel more prepared.

Potential Surgical Risks

• Anesthesia reactions: Rare problems can happen with anesthesia. Tell your doctor if you’ve had any reactions in the past.
• Bleeding: Some bleeding during or after surgery is expected. Your doctor will monitor you closely and manage it as needed.
• Fatigue and breathing trouble: You may feel tired or short of breath for a few days after surgery. This is normal and should improve with rest.
• Infection: This is the most common risk. Your care team will take steps to help prevent it, such as giving you antibiotics when needed.
  

Your doctor will watch for signs of complications and help manage any symptoms during recovery. Sharing your concerns and asking questions before surgery can help you feel more confident about the care you’ll receive.

Common Questions About Pleurectomy and Decortication (P/D) Surgery

Is pleurectomy/decortication the best surgery for pleural mesothelioma?

Many doctors prefer pleurectomy/decortication because it removes cancer but keeps the lung. It can help some people with pleural mesothelioma feel better and live longer. Your care team will decide if it’s the best surgery for you based on your health, cancer stage and cell type.

Can P/D cure mesothelioma?

P/D can’t cure mesothelioma, but it can help control the cancer. It may improve symptoms like chest pain and trouble breathing. Some patients live longer after this surgery. Your doctor will talk with you about your goals and what to expect.

Are there alternatives to pleurectomy for mesothelioma?

Yes, there are other options besides pleurectomy for mesothelioma. One is a more aggressive surgery called extrapleural pneumonectomy, which removes a lung and nearby tissues. Some patients may also try chemo or immunotherapy instead. Your doctor will help find the safest and most effective plan for you.

Can pleurectomy be repeated if mesothelioma recurs?

In some cases, doctors may repeat a pleurectomy if mesothelioma comes back. It depends on your overall health and how much cancer has spread. Your care team will check if another surgery is safe and helpful. 

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