Medical Oncologist
CION Cancer Clinics
Recovery after pleural surgery: what the weeks after pleurectomy and decortication look like | CION Cancer Clinics
After pleurectomy and decortication, expect a hospital stay of a week or two, chest drains for much of it, and several weeks at home before you feel like yourself. Most people are walking within a day or two; the tiredness and the ache in the chest wall take longer. This page walks through the stages, the signs that cannot wait, and what a slow or fast recovery does not mean. 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 does recovery after pleurectomy and decortication look like?
- From the operating table to feeling normal again
- The four things that decide how recovery goes
- Words you will hear, in plain language
- What this page cannot tell you
- Four things families tell us about recovery, and what is true
- Common questions about recovery after pleural surgery
The short answer
What does recovery after pleurectomy and decortication look like?
Expect a hospital stay of a week or two, with chest drains for much of it, and then several weeks at home before you feel like yourself. Most people are walking within a day or two of the operation, but the tiredness, the ache in the chest wall and the effort of breathing deeply take longer to fade.
Why this operation takes longer to recover from
Pleurectomy and decortication means removing the lining of the chest wall and peeling the thickened lining off the surface of the lung, so the lung can expand again. The raw lung surface leaks air and fluid for days afterwards, which is why the drains stay in, and the chest wall has been opened along the ribs, which is why breathing deeply hurts at first. Recovery is mostly about those two things settling.
Who recovers more slowly
Older people, those who were breathless or underweight before the operation, smokers, and anyone who had chemotherapy shortly before surgery tend to take longer. That is expected, not a sign that something has gone wrong.
This page describes a typical course. Your surgeon will tell you what is normal for you, and their word overrides this page.The pathway
From the operating table to feeling normal again
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The first night
Usually in intensive care or a high-dependency bed, with oxygen, a drip, one or two chest drains and a pain pump or an epidural. Nurses check your breathing and the drains through the night. Family can usually visit briefly.
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The first few days
You sit out of bed, then walk the corridor with the drain bottles. The physiotherapist starts breathing exercises and coughing with a pillow held against the chest. Eating restarts quickly. The drains bubble and collect fluid; this is the lung surface healing.
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Drains out and the ward
When the air leak stops and the fluid falls, the drains are removed one at a time. Pain improves noticeably once they are out. You move to a general ward and walk further each day.
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Going home
You leave with pain relief, breathing exercises to continue, a wound-care plan and a date to be seen. Someone should be with you at home for the first week or two.
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The weeks after
Energy returns slowly. Short walks lengthen. The chest wall stays sore and numb in patches for weeks, and the tissue report comes back in this period to guide whatever treatment comes next.
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Signs at home that cannot wait
Sudden or steadily worsening breathlessness, chest pain that is new or sharp, a fever with shivering, a wound that is leaking cloudy fluid or becoming red and hot, a swollen painful calf, or coughing up blood. Any of these needs the surgical team the same day, or the nearest emergency department, saying that you have had chest surgery. Do not wait for the follow-up appointment.
What shapes recovery
The four things that decide how recovery goes
Breathing exercises
Deep breaths and a spirometer, the plastic device with a ball that you breathe into, re-open the small airways and keep chest infection away. Doing them every waking hour is the single most useful thing you can do.
Pain control
You cannot breathe deeply or cough if it hurts too much, so pain relief is taken on a schedule, not only when the pain is bad. Tell the team if it is not enough. Nerve-type pain along the ribs can linger and has its own treatments.
The air leak
The raw lung surface leaks air into the drain for days. It stops on its own in most people. When it persists, you may go home with a small drain and a one-way valve rather than stay in hospital.
Eating and moving
Healing needs protein, so eat small meals often even without appetite. Walking prevents clots and helps the bowels. The physiotherapist sets a plan you increase week by week.
Ask before you
- Lift anything heavy
- Drive
- Travel by road for long distances
On the ward
Words you will hear, in plain language
- Decortication
- Peeling the thickened lining off the lung surface so the lung can expand again.
- Air leak
- Air escaping from the raw lung surface into the drain. Seen as bubbling in the drain bottle. Expected at first.
- Prolonged air leak
- An air leak that goes on longer than the team expected. It is the commonest reason for a longer stay.
- Incentive spirometer
- The plastic breathing device with a ball or piston. It gives you a target for each deep breath.
- Epidural
- A fine tube in the back delivering pain relief around the nerves of the chest wall for the first days.
- Empyema
- Infection in the space around the lung. Uncommon, but the reason the team asks about fever and the colour of drain fluid.
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Being straight with you
What this page cannot tell you
It cannot tell you how your own recovery will go. Two people with the same operation can have very different first fortnights, depending on age, lung function before surgery, how thick the lining was and whether an air leak lingers.
It carries no prognosis
How quickly you recover from the operation says nothing about how the cancer will behave. That depends on the tissue report, the stage, which means how far the disease has spread, and what treatment follows. A slow recovery is not a bad sign, and a fast one is not a promise.
It cannot replace your surgeon's instructions
Your discharge letter sets out your pain relief, your wound care and your follow-up. Where it differs from anything here, follow the letter. Never stop or change a medicine, including blood thinners started after surgery, without asking the team that prescribed it.
What to ask at the follow-up
Ask whether the X-ray has settled, when the tissue report will be discussed, what treatment might follow, and who to call between appointments.
If you are the son or daughter organising this from another town, ask for the discharge plan in writing before the day of discharge.Commonly believed
Four things families tell us about recovery, and what is true
"He should rest in bed until the drains are out."
The opposite. Walking with the drain bottles from the first or second day is what gets the lung open, the bowels moving and the drains out sooner. Bed rest raises the chance of a chest infection and a clot in the leg.
"Taking strong painkillers will make her addicted."
Pain relief after chest surgery is short term and tapered by the team as the chest settles. Untreated pain stops deep breathing and coughing, which is the real danger. Take what is prescribed, when it is prescribed, and say if it is not enough.
"The lung was removed, so he will always be breathless."
Pleurectomy and decortication keeps the lung. The point of the operation is to free it so it can expand. Breathing usually improves over the weeks after surgery as the lung fills the chest, though it depends on how healthy the lung was to begin with.
"Eating less will keep the chest quiet."
Healing a large raw surface needs protein and energy. People who eat poorly after chest surgery heal more slowly and pick up more infections. Small, frequent, protein-rich meals matter as much as the breathing exercises.
Questions we are asked
Common questions about recovery after pleural surgery
How long will the chest drains stay in?
Until the air leak stops and the fluid coming out falls to a small amount, which is usually several days and sometimes longer. The drains, more than anything else, set the length of the stay. A lingering air leak can mean going home with a small drain and a valve instead of waiting in hospital.
When can I go back to work?
Desk work is often possible after a few weeks once tiredness allows. Physical work, lifting and long driving take longer and depend on how the chest wall has healed. Ask your surgeon at the follow-up, and expect the answer to depend on whether further treatment is planned.
Why is the chest still sore and numb weeks later?
The nerves that run along each rib are stretched or bruised when the chest is opened. Numbness, tingling or a band of soreness can last for weeks or months and usually fades. If it is burning or shooting, tell the team, because nerve pain has its own medicines.
Can he climb stairs and walk outside?
Yes, and he should, increasing a little each day. Stairs are fine taken slowly with a pause to breathe. Stop and rest if the breathlessness is more than mild. Avoid lifting, pushing or pulling anything heavy until the surgeon says the chest wall is ready.
When will we know if all the cancer was removed?
The tissue report, ready in the days after surgery, describes what was found and what was removed. With this operation some disease is often left on surfaces that cannot be stripped, which is why further treatment is usually discussed. The report is explained at the follow-up, not over the phone.
Will chemotherapy or radiotherapy follow?
Often something does, but what and when depends on the tissue report and on how you have recovered. Treatment is not started until the chest has healed enough to tolerate it. This is a tumour board decision, discussed with you once the report is back.
What should the wound look like?
Dry, with the edges together, perhaps a little pink and bruised. The drain holes close within days. Redness spreading outwards, warmth, cloudy leakage or a gap opening in the wound needs to be seen the same day. Keep it clean and dry as the discharge letter describes.
Who do we call at night if something changes?
The number on your discharge letter, or the nearest emergency department if the problem is severe. The CION helpline can also help you reach the right person. Keep the letter and a list of medicines where the whole family can find them.
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Sources
- Cancer Research UK — Surgery for mesothelioma
- American Cancer Society — Surgery for malignant mesothelioma
- Macmillan Cancer Support — Mesothelioma
- National Cancer Institute — Surgery to Treat Cancer
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.
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