What is Pleurectomy and Decortication PD Surgery?

[MUSIC PLAYING] The lung-sparing surgery, or operation for mesothelioma, is the pleurectomy/decortication. Mesothelioma is a primary cancer of the pleura. The pleura is the lining of the chest wall, the mediastinum, or the middle compartment of the chest where the heart sits, and the diaphragm. It also lines the entire lung surface into the crevices. It's almost like cellophane in a healthy person. But in mesothelioma, it contains tumor, and the tumor is sort of like a blanket, which is very different than some of the other solid cancers people think of-- like in the breast, colon, and other organs-- where there's a ball or something that you can measure by size. This is sort of a tumor in a blanket. Pleurectomy/decortication removes that blanket. We remove the lining of the chest wall of the middle compartment of the chest, of the diaphragm, and of the lung, and it's a little like peeling the skin off of a tomato. You're kind of not supposed to do that, but you can. And with lung-sparing surgery, we preserve the lung, and we leave it in the patient. Now, if the mesothelioma goes into the sac around the heart, the pericardium, or it goes into the diaphragm, the muscle that separates the chest and the abdomen, those can be removed. That's referred to as an extended pleurectomy/decortication. And then we replace those with mesh. Now, in situations where the tumor invades the lung in many places or actually completely involves the lung, the lung has to be removed as well. For many patients, that's a more difficult surgery to tolerate, and therefore we only do it in patients who are able to tolerate it. And we're finding that we're able to remove all the tumor that's visible even with the lung-sparing pleurectomy/decortication, which is why there has been a shift toward doing that more so than in decades past.