Pleurectomy is the name of a surgical procedure done to remove part or all of the pleura. The pleura is a thin, shiny, slippery, membrane that surrounds the lungs and the chest wall. The pleura consists of two layers of tissue along with lubricating fluid. In most people this area is less than 1mm thick. The outer lining is the parietal pleura, which lines the chest wall and diaphragm. The inner layer is the visceral pleura, which covers the lung and dips into its fissures. Usually the two layers glide smoothly against each other as we breathe. Pleurisy is an inflammation of the pleura.
Pleurectomy was first performed in the 1950’s as a way of treating tuberculosis. It was found with tuberculosis that the lung became entrapped and would develop an empyema. An empyema happens when pus collects in the pleural space and the area needs to be drained as it is impossible to cough up. Eventually the procedure has been used to treat other lung conditions as well, including recurrent pleural effusions, malignant pleural effusions, recurring pneumothorax, and especially malignant pleural mesothelioma.
The recommendation by the doctor to undergo a type of pleurectomy is made after extensive testing, staging of disease, and consideration of the patients physical condition. This operative procedure can be used to treat malignant mesothelioma, and that is the most common indication of this procedure for some patients. The latest statistics are that surgical treatment is performed in approximately 22% of patients with malignant pleural mesothelioma, that figure also includes extra pleural pneumonectomies. Pleurectomies used in the treatment of malignant pleural mesothelioma are also referred to as “lung sparing procedures.” Of the approximately 22% of patients that have surgery it is estimated that pleurectomies account for approximately 17% of the surgical procedures used in the treatment of people diagnosed with malignant pleural mesothelioma
Pleurectomies are recommended after extensive testing and staging of the disease. Pleurectomies can be used in conjunction with decortication. Decortication is the surgical removal of the restrictive layer of fibrous tissue around the lung, chest wall, and diaphragm. Generally, the definition of a pleurectomy is a surgical procedure to remove part of the pleura. The technical definitions of the different pleurectomy procedures are as follows:
1. Extended Pleurectomy /Decortication – also has been referred to as radical pleurectomy- the lung is left in place-refers to removal of all gross tumor with the resection of the diaphragm or the pericardium.
2. Partial Pleurectomy /Decortication – involves partial removal of parietal and or visceral pleura performed for diagnostic or palliative reasons. In this procedure gross tumor is left behind.
3. Pleurectomy/ Decortication – all the pleura lining the chest wall and the coating on the lung parietal and visceral lining on the side with the cancer and removal of all gross tumor without removal of diaphragm and lung. Less extensive of an operation than the extended pleurectomy/decortication.
4. Debulking/ Partial Pleurectomy – removal of as much of the mesothelioma as possible, usually less tissue is removed than in the pleurectomy/ decortication procedure.
A Pleurectomy is done in the operating room under general anesthesia. The incision is made starting along the back and around the lung area between the fourth or fifth rib, it is usually around 4 to 10 inches long. After opening the area, the surgeon will peel away the layer of the pleura and remove the diseased part of the pleural lining. After this part of the surgery is done the surgeon will then, if indicated, do the decortication – which is removal of any visible tumor growth around the lung, diaphragm, and chest wall. Depending on the reason for the surgery more tissue may be removed for testing. Recovery from a pleurectomy involves tubes left in to drain the area. The tubes are usually removed in a few days. Some of the common complications post operatively are a persistent air leak, and infection. Treatment usually involves time for the air leak to close or possibly another procedure.
For some patients with malignant pleural mesothelioma who undergo a pleurectomy, the goal is to increase life expectancy and improve quality of life. Pain is usually reduced, and it allows the person to breathe easier.
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