Pleurectomy with Decortication (P/D)

The surgeon opens the chest through an incision along the side and carefully removes the pleura, the lining that surrounds the lung and lines the chest wall. Tumor coating the lung surface is peeled off so the lung can expand more fully. In an extended version, parts of the diaphragm or the sac around the heart may also be removed and rebuilt with patch material. The goal is to remove all visible tumor, knowing that microscopic disease may remain, which is why other treatments are usually added. Your surgeon can walk you through the specific steps planned for you.

Surgeons look for disease limited to one side of the chest, a favorable cell type, and enough heart and lung strength to recover. Tests may include breathing studies, heart evaluation, PET-CT and sometimes procedures to check lymph nodes. Epithelioid disease is most commonly considered for surgery. Age alone does not rule someone out, but overall fitness does matter. If one surgeon says you are not a candidate, a high-volume mesothelioma center may offer another assessment. Your surgeon may also check lymph nodes before deciding. Other health conditions, such as heart disease or diabetes, are weighed when judging surgical risk.

Hospital stays after P/D often last about a week or longer. Chest tubes drain air and fluid for several days. Common complications include prolonged air leaks, pneumonia and irregular heart rhythms. Breathing exercises and walking begin early. Full recovery takes weeks to months. Chemotherapy or immunotherapy is usually given before or after surgery, and radiation may be used in some cases. Because outcomes depend heavily on surgical experience, asking how often the team performs this operation is reasonable. Ask the team what complications they see most often and how they manage them. Preparing a recovery area at home before surgery can make the transition easier.

1. 1

   Ask the surgeon how many P/D operations the team performs each year.

2. 2

   Ask which tests will confirm whether you are a surgical candidate.

3. 3

   Ask what additional treatment is planned before or after the operation.

4. 4

   Arrange help at home for the first several weeks after discharge.