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 you. What exactly is this type of surgery?  What are the risks 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 2 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 2 to 3 teaspoons) which 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. 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.

Treatment of recurrent pleural effusions or a pneumothorax:

A pleurectomy may also be done for people who have persistent or recurrent pleural effusions (especially malignant pleural effusions) or recurrent or persistent pneumothorax (collapsed lungs) when other procedures (such as pleurodesis) fail to drain and prevent fluid built up between the layers of pleura.

The Procedure

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

The risks of a pleurectomy are similar to those of any surgical procedure and include the risks of general anesthesia, bleeding, and infection. The risk will also relate to the extent of surgery that will be done along with the pleurectomy.

Prognosis

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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