Pleurectomy

• Pleurectomy is a surgical procedure to remove part of the pleura, often performed for conditions like mesothelioma or recurrent pleural effusions.
• The procedure can involve removing either the parietal pleura (lining the chest wall) or both parietal and visceral pleura (lining the lungs).
• Recovery typically involves a hospital stay, pain management, and gradual return to normal activities over several weeks or months.
• Potential risks include bleeding, infection, and air leaks, while benefits often include improved breathing and reduced fluid accumulation.
• The specific type of pleurectomy and recovery timeline depend on the underlying condition and the extent of the surgery.

What is Pleurectomy and How is the Procedure Performed?

Pleurectomy refers to a surgical operation that involves the removal of the pleura, the delicate, two-layered membrane that surrounds the lungs and lines the inner chest wall. This procedure is typically performed to address conditions such as malignant pleural mesothelioma, recurrent pleural effusions (fluid buildup around the lungs), or spontaneous pneumothorax (collapsed lung). The goal is to remove diseased tissue, prevent fluid accumulation, or promote adhesion between the lung and chest wall.

The pleurectomy procedure explained involves several steps, often performed under general anesthesia. The surgeon makes an incision in the chest to access the pleural space. Depending on the extent of the disease, the procedure can be either a parietal pleurectomy, where only the outer layer of the pleura lining the chest wall is removed, or a decortication, which involves removing both the parietal and visceral pleura (the inner layer covering the lung surface) along with any fibrous peel that restricts lung expansion. In cases of mesothelioma, an extended pleurectomy and decortication (EPD) may be performed, which is a more extensive operation designed to remove all visible tumor.

The approach to the surgery can vary:

• Open Thoracotomy: A larger incision is made between the ribs to allow direct visualization and access.
• Video-Assisted Thoracoscopic Surgery (VATS): A minimally invasive technique using small incisions and a camera, often preferred for less extensive cases or for diagnostic purposes.

The choice of technique depends on the patient’s overall health, the underlying condition, and the surgeon’s expertise. For instance, malignant pleural mesothelioma, a rare and aggressive cancer, affects approximately 3,000 people in the U.S. annually, according to the American Cancer Society, often necessitating a pleurectomy as part of its treatment.

Recovery, Risks, and Benefits of Pleurectomy

The recovery after pleurectomy operation varies significantly based on the type and extent of the surgery, as well as the patient’s overall health. Patients typically remain in the hospital for several days to a week, or sometimes longer, especially after an extensive procedure like EPD. During this time, pain management is crucial, often involving epidural catheters or intravenous medications. Chest tubes are usually in place to drain fluid and air, helping the lung re-expand and preventing complications. Physical therapy, including breathing exercises, begins soon after surgery to aid lung function recovery.

Patients are gradually encouraged to increase their activity levels, but a full return to normal activities may take several weeks to months. Follow-up appointments are essential to monitor recovery, manage any lingering symptoms, and address the underlying condition. Long-term recovery often involves ongoing rehabilitation and, for cancer patients, additional treatments like chemotherapy or radiation.

Like any major surgical procedure, there are potential risks and benefits of pleurectomy. The risks can include:

• Bleeding requiring transfusion.
• Infection at the surgical site or in the chest cavity.
• Prolonged air leaks from the lung.
• Pneumonia or other respiratory complications.
• Cardiac complications, such as arrhythmias.
• Nerve damage, leading to pain or numbness.
• Persistent pain or discomfort.

Despite these risks, the benefits can be substantial, particularly for patients with severe or life-threatening conditions. For individuals with recurrent pleural effusions, pleurectomy can prevent fluid buildup, significantly improving breathing and quality of life. In cases of malignant pleural mesothelioma, the procedure can remove cancerous tissue, potentially extending life expectancy and alleviating symptoms like chest pain and shortness of breath. The decision to undergo a pleurectomy is made after careful consideration of these factors, weighing the potential benefits against the risks for each individual patient.