Mesothelioma Pleurectomy with Decortication (P/D)

Quick Summary

The 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.

The Lung-Sparing Mesothelioma Surgery

The pleurectomy with decortication is often called the alternative to the lung-removing EPP. But the P/D is a surgery that stands on its own in terms of survival benefits. The survival times of people getting EPP and P/D are comparable. Most people increase their survival time by a year or more after these surgeries.

“P/D involves opening the chest and removing all visible tumor,” says Dr. Robert Cameron. “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.”

Creation of the P/D

Dr. Robert Cameron perfected the modern P/D. He works at the Pacific Meso Center in California. He believes P/D is as good as any other procedure. He points out the survival times as proof that P/D is effective. Patients who have a P/D seem to live a better quality of life over a longer period of time than ever before.

You can discuss this procedure and other available options with the mesothelioma specialist. They can inform you about the pros and cons of surgery that apply to your diagnosis.

Did you know?

Dr. Robert Cameron treats veterans through the Los Angeles VA. He is one of the top mesothelioma surgeons in the world. No matter where you live, veterans with benefits can receive treatment at the Los Angeles VA. It’s one of the only VA centers with a team dedicated to treating mesothelioma. Learn more about the different types of mesothelioma treatments and surgeries in your free Mesothelioma Veterans Guide.

Surgical Steps of the P/D

This is a lung-sparing procedure. A surgeon removes the lining of the lung but doesn’t remove the lung itself. Unlike the EPP, surgeons don’t remove the diaphragm or pericardium. The surgery lasts about five hours.

Those who have this procedure need to be in fairly good health to tolerate it. Doctors do lung function and cardiac stress tests to make sure the lungs and heart are healthy enough for 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 the decortication, many people have extended their lifespan.

The pleurectomy with is a two-stage procedure:

  1. Pleurectomy. The chest cavity is opened. Pleural mesothelioma begins on and in the lining of the lung. This lining is removed during a P/D.
  2. 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.

There are likely to be mesothelioma cells that aren’t visible to the surgeon. Chemotherapy and radiation can help remove any cancer cells remaining after surgery.

Pleurectomy with decortication typically does not cure mesothelioma. It may lead to long-term survival or disease remission.

Because the lung is spared, people who have this procedure often recover faster than patients who have an EPP.

Did you know?

Pleurectomy with decortication may be an option for older patients and late-stage patients. Studies suggest that older patients can tolerate this surgery better than the EPP. And for late-stage patients, doctors are experimenting with intraoperative procedures. One intraoperative method uses strong beams of light to kill mesothelioma in the chest. The light is placed in the chest during surgery. In one study, patients in stage 3 and 4 had a median survival of 3 years after this treatment.

Recovery from Surgery

After the procedure, the patient can still have blood loss and a 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. Doctors remove the chest tube when there is no more drainage from this area. Patients practice deep breathing exercises after surgery. This helps expand the lungs and prevent pneumonia.

People who have a P/D still need several weeks to recover after leaving the hospital. This is shorter than the time required to heal from the EPP. This is considered to give the patients a better quality of life in the months after surgery.

Often people have chemotherapy or radiation after the surgery. This extends the lifespan of patients in all stages of mesothelioma.

P/D Risks

More than 90 percent of people who undergo the P/D experience a decrease in symptoms after having the procedure. The mortality rate of this procedure in the days following surgery is about 1-2 percent. The biggest complication is a pneumothorax (air leak in the lungs). Bleeding and infection can occur as well.

P/D Benefits

The median survival of patients who receive the P/D is about 20 months. This means that half of all people live less than 20 months and half of all people live longer than 20 months.

Patients live even longer if chemotherapy and radiation are done along with surgery. This is called a multimodal approach. Many cancer cells are left over after surgery. Additional treatments can help get rid of them. Radiation to the original site of mesothelioma, for example, can prevent a recurrence at that site.

Did you know?

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.

Getting a P/D

The pleurectomy with decortication is one of the best treatments for pleural mesothelioma. In the past decades, this procedure has gotten better and better. There are reports of patients living up to 7 years after having P/D along with radiation or chemotherapy.

Things to remember about the P/D:

  • Best for patients in earlier stages.
  • Some late stage patients are eligible for P/D.
  • P/D extends survival time, sometimes by years.

Patients who have a P/D live longer than those who don’t get surgery. If you think this treatment is right for you, talk to your surgeon today. If you are still looking for a specialist, we can help, read about the top doctors now.