Pleurectomy/Decortication (P/D)

Pleurectomy/Decortication is a lung-sparing surgery for pleural mesothelioma in which the surgeon removes the diseased pleura (the lining around the lung) and peels visible tumor off the lung surface, diaphragm, and chest wall, while leaving the lung itself in place. It is one of the two main surgical options for mesothelioma, the other being the more extensive extrapleural pneumonectomy (EPP), which also removes the lung. The goal is macroscopic complete resection, removing all tumor visible to the eye, usually combined with chemotherapy and sometimes radiation.

Origin

The terms come from Latin and Greek roots: "pleura" (rib/side), "-ectomy" (surgical removal), and "decortication" (removing the cortex or outer layer). The operation was refined for mesothelioma in the late 20th century, and standardized terminology (distinguishing "extended P/D," "P/D," and "partial pleurectomy") was formalized by the International Association for the Study of Lung Cancer (IASLC) and the International Mesothelioma Interest Group in 2011.

Significance in Asbestos Context

For patients with pleural mesothelioma, the choice between P/D and EPP is one of the most consequential decisions in the treatment plan. P/D preserves the lung, generally has lower surgical mortality and better quality of life afterward, and is now favored at many major mesothelioma centers, especially for epithelioid subtype and early-stage disease. Eligibility depends on cell type, stage, lung function, and overall health, so it is worth seeking evaluation at a high-volume mesothelioma program before agreeing to any surgical plan. In a legal claim, the type of surgery you undergo, your pathology findings at surgery, and your recovery course become part of the medical record used to document the severity of disease and the cost of care.

Example Sentence

After confirming epithelioid histology and adequate lung function, the thoracic surgeon recommended pleurectomy/decortication rather than EPP, hoping to control the tumor while preserving her breathing capacity.

Related Terms

Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma, Macroscopic Complete Resection, Epithelioid Mesothelioma, Multimodality Therapy, Cytoreductive Surgery

Notes

• Ask whether the surgeon performs an "extended P/D" (which also removes portions of the diaphragm and pericardium) versus a more limited procedure, and how many mesothelioma P/Ds they perform per year. Outcomes are strongly tied to surgical volume.
• Request a second opinion at a designated mesothelioma or high-volume thoracic center (such as an NCI-designated cancer center) before committing to surgery; treatment plans often change after specialist review.
• Preserve all operative reports, pathology reports from resected tissue, and pre- and post-operative imaging. These documents detail tumor extent and are central evidence in both medical follow-up and any legal claim.
• Ask your team how P/D fits into the broader plan: whether chemotherapy or immunotherapy will be given before (neoadjuvant) or after (adjuvant) surgery, and whether radiation is planned.
• Discuss expected recovery, pulmonary rehabilitation, and realistic quality-of-life outcomes. P/D is major surgery even though the lung is preserved.