The pleurectomy with decortication (P/D) is a surgery to remove the lining of the lung affected by mesothelioma and all visible tumors in the chest area. Unlike the extrapleural pneumonectomy (EPP) — the other standard surgery for pleural mesothelioma — the P/D is a lung-sparing operation. Because it’s a less radical procedure, the P/D may also produce fewer complications and risks than the EPP.
Benefits of the P/D
Increased Life Expectancy: Patients with pleural mesothelioma who have received a pleurectomy with decortication are living longer than ever before. Some patients live years past their original prognosis.
Improved Quality of Life: Those who have a P/D experience fewer symptoms of mesothelioma after they recover from surgery. The removal of the affected lining reduces pain and makes it easier to breathe.
Spared Lung: There may be more requirements for P/D eligibility compared to the EPP, but patients who have a P/D don’t have their lung removed.
Are You Eligible for a P/D?
Not every patient diagnosed with pleural mesothelioma is eligible for a P/D. Though it presents less risk than an EPP, the P/D is still a major medical procedure that can put stress on the body. To be considered eligible, a patient must be in good overall health. Healthier patients can withstand the procedure better and recover faster.
The cancer stage of the tumor is important, too. The P/D is only effective for those diagnosed with early–stage mesothelioma that hasn’t spread too far from the lining of the lungs.
What Can You Expect?
The P/D consists of two procedures: the pleurectomy and decortication. With the pleurectomy, a doctor removes any part of the lung’s lining affected by tumor growth. While the chest cavity is still open, the doctor then performs the decortication, removing all visible tumors on the surface of the lung and in the chest area.
First, an anesthesiologist places the patient under general anesthesia. Then, a surgeon makes a 4 to 10 inch long incision (known as a thoracotomy) on one side of the chest to expose the affected lung. To complete the pleurectomy portion of the P/D, the surgeon removes parts of the lung’s lining affected by tumor growth.
VATS (video-assisted thoracoscopic surgery): An experienced surgeon — like Dr. Robert Cameron or Dr. Raja Flores — may decide to perform the P/D with VATS instead of a thoracotomy. To perform VATS, the surgeon uses a technique called “keyhole surgery.” Keyhole surgery gives access to the lung via 3 separate 1–inch–long incisions, or keyholes, made between the ribs. The surgeon guides his or her instruments — inserted through the first two keyholes — with a small camera, which they insert through the third keyhole. Using VATS lowers a patient’s recovery time because it requires less surgery than the thoracotomy.
After the surgeon completes the pleurectomy, he or she begins the decortication portion of the P/D. During decortication, a surgeon removes any visible tumor growth around the lung and in nearby structures, like the chest wall and diaphragm.
Recovering from the P/D
Immediately after the procedure, hospital staff transfers the patient to a recovery room. Nurses track the patient’s vitals — including heart rate, blood pressure and breathing — and watch closely for any post-operative complications.
Patients also receive oxygen via a face mask to help your lungs work back up to normal function. The attending physician may insert a tube into the chest to drain extra blood, fluid, or air that collected in the lungs during the operation. These tubes are connected to a portable bag or bottle, which can usually be removed after two days. Patients can’t eat or drink for at least a few hours after the P/D, but hospital staff provides patients with nourishing fluids through an intravenous (IV) drip.
A day after the procedure, a physiotherapist teaches breathing exercises to help patients strengthen their lungs. Within a week, patients are likely allowed to continue recovery at home.
Risks and Benefits
Risks: Like any surgical procedure, the P/D can cause complications after surgery. Though rare, potential complications include:
- Prolonged air leak (affects 1 in 10 patients)
- Postoperative pain
- Long-term discomfort
Benefits: Patients take less time to recover from a P/D than an EPP — mainly because the P/D doesn’t require the removal of a lung. Patients experience an improvement in quality of life. About 90 percent of pleural mesothelioma patients who have a P/D experience a reduction of symptoms.
The mortality rate associated with the P/D is significantly lower than other surgeries, and according to one study, the median survival time for patients who have a P/D is 29 months — almost 3 times the average life expectancy for mesothelioma patients in general.
The only way to find out if you’re eligible for a P/D — or of it’s the right surgery for you — is to speak with an experienced doctor. They will review your diagnosis and determine if you’re eligible for the P/D, EPP, or any new treatments testing in clinical trials.