Surgery Options for Mesothelioma Patients

A pleurectomy with decortication (P/D) is one possible surgical procedure available to mesothelioma patients. P/D procedures work by removing the affected pleura. This releases the lungs so that they can expand and contract normally again.

With mesothelioma patients, the pleural cavity can fill up and prevent the lungs from expanding to their normal size, making it difficult for meso patients to breathe normally. In healthy patients, the space between the visceral pleura and the parietal pleura is 1mm.


Fibrothorax is a process that involves abnormal fibrous tissues inside the pleural cavity. The presence of these fibers can cause the pulmonary parenchyma to become entrapped, a condition commonly referred to as “trapped lung” or restrictive pleurisy.

What is decortication?

Decortication is a surgical procedure that effectively peels away the layer of abnormal fibers from the lung. By peeling away the layer of fibers that are trapping the lung, the patient’s lungs are free to fill the entire pleural space again, thus relieving the patient’s symptoms (difficulty breathing, etc.)

How does the P/D operation work?

There are five major steps in the P/D procedure, including:

  • Making an incision to expose the parietal pleura
  • Separating the parietal pleura from surrounding tissue (fascia, diaphragm, mediastinum)
  • Cutting the parietal pleural open to reveal the visceral pleura
  • Peeling away – “Decortation” – of the visceral pleura
  • Reconstruction

For the most accurate explanation of the pleurectomy with decortation procedure, consult with a mesothelioma physician.