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Pleurectomy / Decortication

A pleurectomy/decortication, or P/D, is a two-part surgical procedure used to treat pleural mesothelioma in patients who qualify for the surgery. It is less radical than an extrapleural pneumonectomy, which removes the lung in its entirety, but still carries some serious risks and may not lead to remission or a cure of the cancer.

A P/D procedure involves the removal of the pleura, the tissue surrounding a lung, followed by surgery to remove portions of the lung that contain cancerous tissue. This surgery is sometimes called a lung-sparing surgery because it removes as much diseased tissue as possible, but spares the lung. Unlike a pneumonectomy, the patient retains both lungs. The risks are still high with this surgery, but it may extend a patient’s life and bring relief of symptoms of pleural mesothelioma.

What Is P/D?

Pleurectomy/decortication is a complex, two-part surgery that removes the pleura and diseased portions of a lung. The first step in performing a pleurectomy/decortication surgery is to make an incision, typically on the patient’s side, from the back to the chest. The next stage is the pleurectomy. This is the removal of the pleural tissue, the double-layer of tissue that is the source of mesothelioma.

The final stage of a P/D is to remove any tumors or cancerous and diseased tissue of the affected lung. The amount of tissue that needs to be removed will vary depending on the patient and the extent to which the cancer has spread to the lung. If the cancer is in the lung closest to the heart, part of the tissue surrounding the heart, called the pericardium, may also be removed.

A P/D procedure is also likely to be followed by chemotherapy, radiation therapy, or a combination of the two. These therapies may kill any remaining cancer cells and are used to reduce the risk that the cancer will recur later. For many people the cancer will come back, but this step lowers that risk and extends the time before the recurrence happens.

The Possible Benefits of P/D

There are several goals for a patient undergoing a P/D. The benefits that a patient may experience have to be weighed against the potential risks of the surgery. One main benefit is that it provides an alternative to an extrapleural pneumonectomy, a surgery that is radical, risky, and comes with a significant mortality rate. Some patients may not want to risk undergoing such an extensive surgery, or are not good candidates for it, but may benefit from P/D as an alternative.

A main goal of performing a P/D for someone with pleural mesothelioma is to slow the progression of the disease. By removing a significant amount of cancerous tissue, including the pleural, the surgeon may give the patient a chance to live longer as the spread of the cancer cells is temporarily halted or slowed.

Additionally, the benefits of P/D include relief of symptoms, a benefit that as many as 90 percent of patients see. Pleural mesothelioma symptoms can be debilitating and uncomfortable and have a big impact on quality of life. Removing some of the diseased tissue may relieve chest pains, help the patient breathe better, and relieve pressure from the buildup of fluid in the chest cavity. Relief from these symptoms improves quality of life and helps people be more active in the time they have left.

Risks and Complications

The potential complications of a P/D are less than those of the more extensive extrapleural pneumonectomy, but there are risks. This is still a radical and complicated surgery and complications are possible, including death. The mortality rate for this surgery ranges from one to two percent, which is much lower than that for an extrapleural pneumonectomy.

Complications may include respiratory distress or failure, inflammation or fluid buildup in the lungs or chest cavity, air leaking from the chest cavity, heat problems, including arrhythmias, infections, like pneumonia, bleeding, blood clots, and complications related to going under general anesthesia.

Patients who May Undergo a P/D

A pleurectomy/decortication procedure may be the best choice for a mesothelioma patient who is not in good enough health to undergo an extrapleural pneumonectomy or a pneumonectomy, but who may benefit from a less radical surgery. Patients undergoing P/D must be in good enough health, with no or limited comorbid conditions. Pulmonary and heart health are particularly important.

Age and extent of the cancer are also factors that are considered when vetting patients for this surgery. Older patients may be unable to withstand the physical distress of the surgery or may be able to undergo the surgery, but not the adjuvant treatments. The extent to which the cancer has spread is also a consideration. Extensive surgeries are not usually performed on patients whose cancer has spread beyond the lungs and chest cavity. There may be exceptions and a P/D may be performed for a patient as part of palliative care, when other, less invasive treatments have not brought relief from symptoms.

Recovering from P/D

Recovery from this type of surgery takes time, but is usually quicker than with an extrapleural pneumonectomy. Because the patient does not lose an entire lung, recovering the ability to breathe easily comes sooner and more readily. Even so, the surgery is major and patients must stay in the hospital for at least a week. The patient may need to have infections treated, to have fluid drained from the chest cavity, or to receive breathing therapy. Full recovery may take several weeks and if there are complications a patient may live with some limitations indefinitely.

A pleurectomy/decortication surgery is one option that many mesothelioma patients have for extending life expectancy and improving quality of life. While the surgery is major and there are risks, the risks are lower than with more invasive surgeries and the benefits are often found to be worth the risks. If you are facing decisions over treatments for mesothelioma, find out all the information you can, talk to your family and your doctors, and weigh the risks and benefits before making this important decision.

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