Pleurectomy with decortication is a popular treatment for pleural mesothelioma that strips the lining of the lungs where mesothelioma grows. It’s mostly for early-stage patients but is also used in some stage 3 or 4 patients if the circumstances allow.
What is Pleurectomy with Decortication?
Pleurectomy with decortication (P/D) is a surgery used to treat pleural mesothelioma. It allows patients to keep their lung, unlike an extrapleural pneumonectomy (EPP).
This surgery involves creating an opening in the chest cavity and then entering that cavity to remove all visible tumors inside the lungs as well as the lining of the lungs. While the lining is removed, this surgery allows patients to keep both of their lungs.
This two-step surgery was created by Dr. Robert Cameron, an expert in pleural mesothelioma. He has performed this surgery on hundreds of mesothelioma patients over the years.
The survival rates of people who receive an EPP and P/D are similar. Most people increase their survival time by a year or more after these surgeries and enjoy a better quality of life after getting P/D.
The Mesothelioma Veterans Center has no affiliation with and is not endorsed or sponsored by Dr. Robert B. Cameron. The contact information above is listed for informational purposes only. You have the right to contact Dr. Cameron directly.
How Can P/D Help Me?
P/D is one of the best treatments for pleural mesothelioma, and it has been proven to be beneficial for many who receive it.
Patients are afforded a longer life, faster recovery time, and reduced mortality risk. Because this surgery spares the lung, it is not as physically demanding. Because of this, it is often recommended for older patients who may not survive an aggressive EPP.
More than 90% of people who undergo P/D experience a decrease in symptoms after having the procedure. It also lowers a patient’s risk of complications post-surgery.
P/D involves opening the chest and removing all visible tumors. Instead of removing the lung, you carefully separate the tumor from the healthy lung. This can be done very completely so it provides just as much tumor clearance as taking out the lung in an EPP.
— Dr. Robert Cameron
How Do I Get P/D?
To get P/D, mesothelioma patients need to work with specialized doctors. These mesothelioma doctors practice out of private cancer centers and VA-affiliated hospitals throughout the country.
For veterans with mesothelioma, there are two major specialists in pleural mesothelioma who perform P/D within the VA Health Care System.
Dr. Robert Cameron
Dr. Robert Cameron treats veterans through the Los Angeles VA. He is one of the top mesothelioma surgeons in the world and the creator of P/D.
Dr. Cameron has more than two decades of experience in treating mesothelioma. He also can help civilians with mesothelioma because he also practices out of the Ronald Reagan UCLA Medical Center.
Dr. Avi Lebenthal
If you need a pleural mesothelioma specialist on the east coast, Dr. Avi Lebenthal works at the Boston VA Hospital. As a veteran of the Israeli army and a pleural mesothelioma specialist, Dr. Lebenthal can see his patients from a unique perspective.
Veterans can get treatment from these doctors regardless of where they are healthy enough to travel to Los Angeles or Boston. Non-VA cancer centers will accept any patient, and some of these local providers may accept VA health care coverage under new policies.
Who Qualifies for P/D?
Aggressive surgeries such as P/D are usually only for those with early-stage pleural mesothelioma. However, P/D may be an option for older patients as well.
Those who have this procedure need to be in fairly good health to tolerate it. Your mesothelioma doctor can determine if you can get P/D through a series of tests.
These tests include:
- Biopsies from the different sites of pleura, the lining of the lungs
- CT scan of the upper chest and abdomen
- PET-CT scan
- Pulmonary Function Test (PFT) to test heart function
- Quantitative Ventilation and Perfusion (V/Q) scan to test lung function
While this surgery is usually used for patients in the early stages, some patients in the later stages — stages 3 or 4 — may be able to safely have P/D. Some studies suggest that older patients can tolerate this surgery better than an EPP.
P/D Surgical Steps
P/D is a two-step procedure that consists of:
- Pleurectomy: The chest cavity is opened. Pleural mesothelioma begins on the lining of the lung, so this lining is removed during P/D. Unlike an EPP, surgeons don’t remove the diaphragm, pericardium (lining of the heart), or lung.
- Decortication: Surgeons remove any tumor masses visible inside the lung space. They also remove tumors from the fatty areas between the lobes of the lung. If tumors are visible on the diaphragm or pericardium, they are also removed.
In total, the surgery lasts about 5 hours. Even after this surgery is complete, there may still be mesothelioma cells that aren’t visible to the surgeon. Chemotherapy and radiation can help remove any cancer cells remaining after surgery.
Historically, patients underwent pleurectomy without decortication. Doctors used it as a palliative surgery meant only to keep the patient more comfortable. With the addition of decortication, many people have extended their survival time.
Recovery from Surgery
Because P/D is less invasive and the lung is spared, people who have this procedure often recover faster than patients who have an EPP. People who have P/D will need several weeks to recover.
However, specialists feel the shorter recovery time gives patients a better quality of life following surgery.
After surgery, the patient can still have blood loss and buildup of fluid around the lungs. A chest tube is placed to drain the excess blood and fluid out of the surgical space for a few days. When there is no more draining from the area, doctors remove the chest tube.
Patients practice deep breathing exercises after surgery which helps expand the lungs and prevent pneumonia.
If chemotherapy or radiation must be used to kill any leftover mesothelioma cells, this is typically done after surgery.
Risks and Benefits of P/D
Though there are some risks to P/D, there are also many benefits.
The biggest complication is a pneumothorax (air leak in the lungs), while bleeding, infection, and atrial fibrillation can also occur. There is always a risk of surgical complications, but a specialist work to keep patients as safe as possible.
Only 1-2% of patients die from complications following P/D.
After P/D, more than 90% of people experience a decrease in symptoms. Patients are more likely to notice a positive change in their breathing and overall physical health. P/D can also greatly increase the lifespan of those who receive it.
P/D Survival Rates
Survival rates of patients who receive P/D are typically higher than those who do not get any type of surgery.
The median survival of patients who receive P/D is about 20 months. Patients live even longer if chemotherapy and radiation are done along with the surgery. This is called a multimodal approach. Radiation to the original site of mesothelioma, for example, can prevent a recurrence (when the mesothelioma comes back).
In one study done in 2009, people who had all three forms of therapy had a median survival rate of around 30 months. That’s 10 months longer than the average for P/D surgery alone.
Next Steps to Get P/D
For patients with pleural mesothelioma, P/D could make the difference between living only a few months and achieving long-term survival. This surgery is less invasive than an EPP, so patients can recover faster and with a lower risk of complications.
Veterans enrolled in the VA Health Care System can get P/D at some of the top VA hospitals in the country. These cancer centers employ pleural mesothelioma specialists like Dr. Cameron and Dr. Lebenthal, who are highly skilled in performing this type of surgery.