What is a pleurectomy?

Pleurectomy
A pleurectomy is a surgical procedure that is done to remove part of the pleura. Pleurectomy is indicated for an individual who has recurrent lung diseases or infections.

Lungs are surrounded by a thin lining called pleural membrane (pleura). Pleura help lungs move with ease during respiration. A pleurectomy is a surgical procedure that is done to remove part of the pleura. Pleurectomy is indicated for an individual who has recurrent lung diseases or infections. 

Why and how is a pleurectomy performed?

There are a few different reasons why a doctor may recommend a pleurectomy which include:

  • Mesothelioma: Mesothelioma is cancer-related to asbestos exposure. This can arise from the pleural linings (pleural mesothelioma) as well as the thin linings that cover the heart and abdomen. The most common indication for a pleurectomy is to treat malignant mesothelioma (aggressive cancer which can spread). When a pleurectomy is used to treat mesothelioma, it is often combined with a procedure called decortication (pleurectomy decortication). This procedure involves not only the removal of the pleura but also of any adjacent tumor that may be present in the chest cavity.
  • Recurrent pleural effusions: A pleurectomy may also be done for people who have persistent or recurrent pleural effusions (excess fluid accumulates in the space between the lungs and the chest cavity). Sometimes, a pleural effusion spread to several separate areas in the lungs. The build-up of fluid can then be prevented by removing the pleura altogether.
  • Malignant pleural effusions: Malignant pleural effusions are the pleural effusions that contain cancer cells. They may arise from primary lung cancer or due to metastases from other cancers such as breast cancer. Although the treatment of malignant pleural effusions is most often palliative (the procedure is done to improve quality of life but not to cure a disease), controlling the build-up of fluid can often improve shortness of breath and decrease pain.
  • Recurrent pneumothorax (accumulation of air in the lungs): For people who have had two or more collapsed lungs, a pleurectomy may be done to prevent another recurrence.? Removing the linings of the lungs (the pleura) leaves no space where air can accumulate.

A pleurectomy is usually done under general anesthesia in the operating room. During the procedure, an incision is made along the back and parallel to the lungs (thoracotomy). After gaining access to the chest, the surgeon then carefully peels away and removes the layers of pleura. Additional tissue may be removed if the doctor is operating for mesothelioma. Before the incision is closed, drainage tubes are placed which will be removed later on when the bleeding and discharge are small. The incision is then closed, often with sutures that will dissolve on their own. The procedure is usually completed within four hours. 

What are the risks involved in pleurectomy?

As with any surgical procedure, there are potential risks and complications. Risks of pleurectomy include:

  • Anesthesia-related headache, nausea, and drowsiness
  • Bleeding
  • Infection
  • Damage to the lungs and other organs in the chest cavity
  • Persistent air leak (sometimes it can be difficult to remove a chest tube following a pleurectomy due to a persistent air leak)
  • Recurrence of pleural effusion or pneumothorax due to include inadequate removal of pleural tissue
  • Scar tissue (adhesions) may develop in the chest and chronic pain may occur in some people

What is the outcome of pleurectomy?

Respiratory therapy is usually involved throughout the recovery period, helping people to breathe deeply and get out of bed quickly to lower their risk of pneumonia, blood clots, and other complications. Pulmonary rehabilitation may be recommended down the line as well to improve breathing. A pleurectomy is a surgical procedure that carries risks, but can sometimes greatly improve quality of life for people living with mesothelioma or a malignant pleural effusion. For those who have been coping with a recurrent collapsed lung or recurrent pleural effusions, a pleurectomy can sometimes resolve the problem completely.

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Medically Reviewed on 7/15/2020
References
REFERENCES:

Pleurectomy: (https://emedicine.medscape.com/article/1894301-overview)
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