What is a Pleurectomy?

What Should You Know About Having a Pleurectomy?

surgeons operating on a patient
What kind of procedure is a pleurectomy?. Istockphoto.com/Stock Photo©nimon_t

Your doctor may have recommended a pleurectomy as a surgical procedure for recurrent pleural effusions, pneumothoraces, or mesothelioma.. What exactly is this type of surgery? What are the risks and possible complications, and what is the prognosis?

Definition of Pleurectomy

A pleurectomy is a surgical procedure that is done to remove part of the pleura, the linings that surround the lungs. The lungs are surrounded by two pleural membranes; the parietal pleura on the outside, closest to the chest wall, and the visceral pleura on the inside, closest to the lungs.

Between the pleura lies the pleural cavity. Ordinarily, there is a small amount of fluid in this space (roughly two to three teaspoons) which cushions and helps to lubricate the lung linings during respiration.

Reasons for a Pleurectomy

There are a few different reasons why your doctor may recommend a pleurectomy:

  • Treatment of mesothelioma - The most common indication for a pleurectomy is to treat malignant mesothelioma. This cancer, which is often related to asbestos exposure, can arise from the pleural linings (pleural mesothelioma) as well as the linings of the heart and abdomen. When a pleurectomy is used to treat mesothelioma, it is often combined with a procedure called decortication (pleurectomy decortication.) These procedures involve not only the removal of the pleura but of any adjacent tumor that may be present in the chest cavity. An alternative surgery for mesothelioma is an extrapleural pneumonectomy, a more invasive procedure. Despite a higher complication rate with extrapleural pneumonectomy, survival appears to be similar between pleurectomy decortication and extrapleural pneumonectomy
  • Treatment of recurrent pleural effusions or a malignant pleural effusion - A pleurectomy may also be done for people who have persistent or recurrent pleural effusions when other procedures (such as pleurodesis) fail to drain and prevent fluid built up between the layers of pleura. In a pleurodesis, a chemical is placed between the two linings of the lungs in an attempt to scar these layers together. Sometimes a pleural effusion is "multiloculated" meaning that there are several separate areas in which fluid can build up. This can make either inserting a stent or pleurodesis ineffective. By removing the pleura altogether, the build up of fluid can then be prevented.
  • Treatment of malignant pleural effusions - Pleurectomy is used in a similar way to treat malignant pleural effusions. Malignant pleural effusions are pleural effusions in which cancer cells are present. They may arise from a primary lung cancer, or due to metastases from other cancers such as breast cancer. While the treatment of malignant pleural effusions is most often palliative, controlling the build up of fluid can often improve shortness of breath and decrease pain.
  • Treatment of a recurrent pneumothorax - If you've suffered two or more pneumothoraces (collapsed lungs) a pleurectomy may be done to prevent another recurrence.

The Procedure

A pleurectomy is usually done under general anesthesia in the operating room.

In a pleurectomy, an incision is made along the back and parallel to the lungs (a thoracotomy.) After gaining access the surgeon then carefully peels away and removes the layers of pleura. Additional tissue may be removed if your doctor is operating for mesothelioma. Before the incision is closed, drainage tubes are placed which will be removed later on when the bleeding and discharge is small. The incision is then closed, often with sutures which will dissolve on their own.

Risks and Complications of Pleurectomy

The risks of a pleurectomy are similar to those of many other surgical procedures and include:

  • The risk of general anesthesia
  • Bleeding
  • Infection
  • Damage to the lungs and other organs in the chest cavity
  • Persistent air leak

Complications may include inadequate removal of pleural tissue so that a pleural effusion or pneumothorax recurs. Scar tissue (adhesions) may develop in the chest and chronic pain may occur for some people.

With mesothelioma, the risks often depend on the extent of the cancer and the ability of the surgeon to access and remove the cancerous tissue.

After Surgery

Respiratory therapy is usually involved throughout your recovery period, helping you to breathe deeply and get our of bed quickly to lower your risk of pneumonia, blood clots, and other complications. Pulmonary rehabilitation may be recommended down the line as well to improve breathing.

Prognosis after Pleurectomy

In general, a pleurectomy is tolerated quite well. For people with malignant mesothelioma, it is most often a palliative treatment, meaning that it is done to reduce symptoms and improve comfort but does not cure the disease.

A pleurectomy for people with mesothelioma may improve life expectancy, and improve symptoms of shortness of breath.

Examples After Ken was diagnosed with mesothelioma, his doctor recommended he have a pleurectomy plus decortication to remove the tumor in his pleura and surrounding chest cavity.

Sources:

Cao, C. et al. A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma. Lung Cancer. 2014. 83(2):240-5.

Hasegawa, S. Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma. General Thoracic and Cardiovascular Surgery. 2014. 62(9):516-21.

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