What Is Pleurectomy/Decortication (P/D)?

Understanding P/D Surgery

Pleurectomy/decortication (P/D) is a surgical procedure for malignant pleural mesothelioma that removes the diseased pleural membranes and strips away all visible tumor from the chest wall, lung surface, mediastinum, and diaphragm — while preserving the underlying lung. The “pleurectomy” component refers to removal of the parietal pleura, and “decortication” refers to peeling the tumor and visceral pleura from the lung surface.

In an extended P/D, the surgeon also removes and reconstructs the diaphragm and/or pericardium if tumor has invaded those structures. This lung-sparing approach has become increasingly favored at many leading mesothelioma centers over the past decade.

P/D vs. EPP

The choice between P/D and EPP has been one of the most debated topics in mesothelioma surgery. P/D offers several advantages: lower perioperative mortality (1–4% vs. 3–7% for EPP), better preservation of lung function and quality of life, shorter hospital stay, and comparable or potentially superior long-term survival in retrospective studies.

Large retrospective analyses, including a landmark study from the International Association for the Study of Lung Cancer (IASLC), have not shown a definitive survival advantage for EPP over P/D. Today, many high-volume centers have shifted toward P/D as the preferred approach, particularly for patients with epithelioid cell type.

The Procedure and Recovery

P/D is performed under general anesthesia through an extended thoracotomy. The surgeon methodically removes the parietal pleura from the chest wall, then carefully decorticates tumor and visceral pleura from the lung. If the diaphragm or pericardium are involved, they are resected and reconstructed with prosthetic material.

Hospital stay typically ranges from 5–10 days. Because the lung is preserved, patients generally recover faster than after EPP. Most patients return to daily activities within 4–6 weeks. Pulmonary rehabilitation and breathing exercises optimize recovery.

Outcomes and Survival

When performed as part of a multimodal treatment plan, P/D has demonstrated median survival of 20–30 months, with some series showing median survival exceeding 30 months for patients with epithelioid histology and complete macroscopic resection. Long-term survivors living five or more years have been reported.

As with any mesothelioma treatment, outcomes depend on disease stage, cell type, completeness of resection, and the expertise of the treating team.

Financial and Legal Resources

Major surgery and multimodal treatment impose significant financial burdens. Because mesothelioma is caused by asbestos exposure, patients may be entitled to substantial compensation through legal claims, trust fund filings, or VA benefits for veterans.

At Danziger & De Llano, we have helped mesothelioma patients pursue the compensation they deserve for over 30 years. Call 1-800-400-1805 for a free consultation.