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Pleurectomy and decortication: removing the lining, keeping the lung | CION Cancer Clinics
Pleurectomy and decortication is a major chest operation that removes the lining of the chest and peels the thickened layer off the lung, while the lung itself stays. It is mainly used for pleural mesothelioma in a small group of fit people. It aims to remove all visible cancer and help a squashed lung expand. This page explains the versions, the recovery, the risks and who it does not suit. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is pleurectomy and decortication?
- What are the different versions of the operation?
- What happens before, during and after the operation?
- What words might you see in the surgical notes?
- What do people often get wrong about this operation?
- Who is this operation not for, and what is still uncertain?
- Common questions about pleurectomy and decortication
The short answer
What is pleurectomy and decortication?
Pleurectomy and decortication is an operation that removes the lining of the chest and peels the thickened layer off the surface of the lung, while leaving the lung itself in place. It is mostly used for pleural mesothelioma, a cancer of that lining, and it is a major operation.
What the two words mean
The pleura is the thin double lining around each lung. Pleurectomy means removing the part that lines the inside of the chest wall. Decortication means stripping the diseased layer, sometimes called the rind or peel, off the lung, so the lung can open out again. Surgeons often shorten the name to P/D.
What it is meant to do
The aim is to remove all the cancer the surgeon can see, and to let a squashed lung expand so breathing is easier. It does not remove every cancer cell, because mesothelioma spreads as a thin film. That is why it is usually one part of a wider plan that includes chemotherapy, immunotherapy or radiotherapy.
This page describes the operation in general. Whether it is a sensible option for you is a decision for your treating team and you, based on your scans, biopsy and fitness.Not one operation
What are the different versions of the operation?
Ask your surgeon which one they mean. The size of the operation and the recovery are quite different.
Partial pleurectomy
Only part of the lining is removed, often by keyhole surgery. It is mainly done to control fluid or to relieve symptoms rather than to remove all visible cancer.
Usually aimed at
- Fluid that keeps coming back
- A lung that cannot open fully
Pleurectomy and decortication
All the lining on one side is removed through a larger cut between the ribs, and the rind is peeled from the lung. The breathing muscle and the sac around the heart are left alone.
Extended pleurectomy and decortication
As well as the lining, the surgeon removes part of the diaphragm, the dome-shaped breathing muscle, and part of the pericardium, the sac around the heart. Both are rebuilt with a patch.
This is the largest version, used when cancer has reached those areas.Not sure whether this applies to you?
Ask an oncologistThe pathway
What happens before, during and after the operation?
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Fitness tests
Breathing tests, a heart scan and blood tests check that you could cope with the operation. If you take blood thinners such as aspirin, clopidogrel or warfarin, tell the team. They will tell you what to do with them. Do not stop any medicine on your own.
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The operation
You are fully asleep. The surgeon works through a cut along the side of the chest, between the ribs. The operation takes several hours because the lining has to be separated carefully from the lung.
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Intensive care or high dependency
Most people spend the first night or longer being watched closely. You will have chest drains, a drip and pain relief, often through a thin tube in the back.
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On the ward
The drains stay in until air and fluid stop leaking from the lung surface. This often takes longer than after other chest operations. Physiotherapists help you breathe deeply, cough and walk.
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Home and further treatment
Recovery at home takes months. Your oncologist will then discuss whether you need chemotherapy, immunotherapy or radiotherapy.
!
After you go home, one thing that cannot wait
If breathlessness suddenly gets much worse, you have new chest pain, you cough up blood, you have a fever with shivering, or the wound becomes red, swollen or leaks pus, go to the nearest emergency department the same day. Say you have had chest surgery for mesothelioma. Do not wait for your next appointment.
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On your notes
What words might you see in the surgical notes?
- Visceral pleura
- The layer of lining stuck directly to the lung.
- Parietal pleura
- The layer that lines the inside of the ribs and chest wall.
- Air leak
- Air escaping from the lung surface into the drain after the lining is peeled away. It is common and usually settles with time.
- Macroscopic complete resection
- The surgeon removed all the cancer that could be seen or felt. Tiny cells may still remain.
- Trapped lung
- A lung held down by a thick rind so it cannot expand. Decortication aims to free it.
Commonly believed
What do people often get wrong about this operation?
"Keeping the lung means it is a small operation."
It is still one of the larger chest operations. Peeling the lining off the lung takes hours, and the air leaks that follow can keep you in hospital for some time. Plan for a long recovery.
"Once it is removed, no more treatment is needed."
Mesothelioma spreads as a thin film, so some cells are usually left behind. Most people are advised to have further treatment with medicines or radiotherapy, and regular scans afterwards.
"Breathing will be back to normal straight away."
Breathing may feel easier once a trapped lung can open, but the cut, the drains and weak muscles make the first weeks hard. Breathing exercises and walking help it improve gradually.
"Everyone with mesothelioma should ask for this."
Only a small group are fit enough and have the right type and extent of disease. For many people, medicines and fluid control do more good with less harm.
Being straight with you
Who is this operation not for, and what is still uncertain?
It is generally not advised when the cancer is the sarcomatoid type, when it has spread to both sides of the chest or beyond, or when heart and lung tests show the body could not recover from a major operation. People who are already very breathless at rest, or who spend most of the day in bed, are rarely offered it.
The evidence is debated
A large UK trial found that adding the extended operation to chemotherapy did not help people live longer on average, and it caused more serious problems. Some specialist teams still offer it to carefully selected people. Ask your surgeon how that evidence applies to you.
Questions worth asking
What is the operation meant to achieve for me? Which version do you plan? How often does your team do it? What would happen if I did not have it? What further treatment will follow? Would I be part of a study?
This page cannot tell you how things will go for you. Only the team who has seen your scans and biopsy can talk about that.Questions we are asked
Common questions about pleurectomy and decortication
Is pleurectomy and decortication done by keyhole surgery?
A partial operation to control fluid can often be done through small cuts with a camera. The full operation to remove all visible cancer is usually done through a larger cut between the ribs, because the surgeon needs to reach every part of the lining. Ask which approach is planned for you.
How long will I be in hospital?
It varies more than most operations, because you stay until the drains can come out, and that depends on how quickly air stops leaking from the lung. Your surgeon can give you a typical range for their unit. Plan for a family member to stay nearby.
Will I have a lot of pain afterwards?
A cut between the ribs is sore, and good pain relief matters because it lets you breathe deeply and cough. Many people have a thin tube in the back that numbs the chest for the first days. Some people have aching around the scar for months. Tell the team if pain stops you breathing deeply.
What are the main risks?
The most common is an air leak that keeps the drains in longer. Others include bleeding, chest infection, an irregular heartbeat, and problems with the patch if the breathing muscle was rebuilt. Your surgeon should explain which risks apply most to you and how they are watched for.
Will I need chemotherapy or radiotherapy as well?
Usually, yes. Because tiny amounts of cancer tend to remain, most people are advised to have other treatment before or after the operation. Your medical oncologist will explain which treatment is suggested and when it would start once you have recovered.
How is this different from removing the whole lung?
Removing the whole lung, called extrapleural pneumonectomy, takes the lung out along with the lining. Pleurectomy and decortication keeps the lung. Many specialist centres now prefer keeping the lung when they operate. Our comparison page explains the differences in more detail.
When can I go back to work or travel?
Desk work may be possible after a few months for some people, and heavy physical work takes longer. Long journeys by bus or train are tiring early on. Ask your surgeon before any flight, because air in the chest must have fully settled first.
What should the family prepare at home?
A bed that is easy to get in and out of, extra pillows to sleep propped up, help with bathing and cooking for the first weeks, and someone who can bring you to follow-up visits. Keep the discharge summary and the ward phone number where everyone can find them.
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Dr. Vajja Sandeep Kumar
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Sources
- NHS — Mesothelioma: treatment
- National Cancer Institute — Malignant Mesothelioma Treatment (PDQ), patient version
- Cancer Research UK — Mesothelioma
- American Cancer Society — Malignant Mesothelioma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Extrapleural Pneumonectomy vs PleurectomyHow keeping the lung compares with removing itWho Is a Candidate for Mesothelioma SurgeryWhat the team checks before offering this operationRecovery After Pleural SurgeryThe weeks and months after you go homeDrains, Tubes, Lines and CathetersWhy the chest drains stay and how they come out
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Been told about pleurectomy and decortication?
Send us the scans and biopsy report, or call the helpline. A surgical oncologist will explain what is being proposed and why. One helpline serves every CION centre.