A pleurectomy is a surgical procedure to remove part or all of the pleura, a membrane that lines the lungs and chest cavity. The procedure treats empyema — an infection of the pleural cavity — and other lung conditions.

The pleural cavity is the space between the outer and inner layers of the pleura.

A pleurectomy involves the removal of part of the outer or inner pleura. A pleurectomy/decortication (P/D) involves removing both the inner and outer pleura, along with any tumors or fibrous tissue.

This article looks at pleurectomy procedures, the risks, purposes, what to expect, and more.

A person with a hand on their chest and a surgeon performing a pleurectomy. Share on Pinterest
Design by MNT; Photography Vichuda Sirisarakar/EyeEm/Getty Images & Georgiy Datsenk /EyeEm/Getty Images

During a pleurectomy, surgeons remove the inner or outer pleura, or both.

Depending on the reason for a pleurectomy, the surgery may aim to:

  • relieve symptoms of certain conditions by removing fluid buildup in the pleural cavity
  • obtain biopsies to diagnose certain conditions
  • treat cancers such as mesothelioma by removing tumors in the case of a P/D

There are many different techniques for performing a pleurectomy. They include:

  • Partial pleurectomy: This is a procedure wherein surgeons remove excess tissue from the pleural cavity. This may be an emergency surgery when there are lung complications. It may also be a planned operation for people with ongoing lung problems.
  • P/D: In this technique, surgeons remove the inner and outer pleura and any tumors or fibrous tissue. They will not remove the diaphragm or the pericardium, the membrane that covers the heart.
  • Extrapleural pneumonectomy: Surgeons will remove the inner and outer pleura, as well as part of the lung on the affected side. They will also remove the diaphragm and the pericardium.
  • Extended P/D: Surgeons remove the inner and outer pleura and any tumors, as well as the diaphragm and pericardium.

Not everyone is eligible for a pleurectomy.

Candidates for this procedure must be in relatively good health and should not smoke. If they do, they will need to quit smoking well before the operation.

Eligibility also depends on the purpose of the pleurectomy. For example, if the aim is to treat mesothelioma, the cancer must not have spread too far out of the lungs. Otherwise, surgeons may be unable to remove all of the cancer cells, and the risks of the surgery would outweigh the benefits.

Before surgery, the person will receive general anesthesia so that they will be unconscious.

Then, a healthcare professional will intubate the person, inserting a tube through their mouth and into the throat to help them breathe during surgery. Medical professionals will position the person on their side to give the surgeon easy access to the operating area.

Surgeons may use a keyhole surgery method for the procedure. This involves the surgeon making several small incisions instead of one large cut and performing the surgery through these small openings.

If the person requires a more complex operation, surgeons may make a bigger incision. They will slowly and carefully open the ribs before removing parts or all of the pleura.

Before the operation, a team of medical professionals will tell the person exactly what will happen during their surgery. They will be available to answer any questions a person may have about their specific procedure.

A person’s surgical team will advise on any steps they may need to take in preparation for a pleurectomy. For example, a doctor may recommend a person avoid eating anything the night before the operation.

Additionally, in some cases, doctors may advise that a person stop taking certain medications for some time before the procedure.

These may include blood-thinning medicines or nonsteroidal anti-inflammatory drugs. People must discuss any medications that they take with a healthcare professional.

People who smoke and require a pleurectomy will need to quit smoking well before the procedure, as smoking complicates lung diseases and can slow a person’s recovery after surgery.

According to Cancer Research UK, most people will stay in the hospital for around 7–15 days following a pleurectomy, depending on the technique their surgeons use.

It states that it can take a person 4–8 weeks to fully recover after surgery, meaning it may be a while before they are ready to return to work or resume their daily activities.

Many studies have demonstrated the effectiveness of a pleurectomy in prolonging the life of people with conditions such as mesothelioma.

Research also suggests that those who receive a pleurectomy may have a better quality of life and fewer postoperative complications than those who had a procedure to remove the lungs.

As with any surgery, a pleurectomy has some risks and side effects.

The risks of a pleurectomy mainly relate to complications from the anesthesia, such as breathing difficulties or allergic reactions. Other risks include infection, bleeding, and lung complications.

The side effects relate more to the effects of the procedure itself. They include pain or discomfort in the chest area, swelling in the affected lung or chest cavity, and difficulty breathing due to decreased lung capacity.

For most people, postoperative pain and discomfort will eventually subside. A doctor will likely prescribe pain medication to make a person more comfortable after surgery.

The main goal of this procedure is to improve breathing and reduce pain by removing diseased tissue from the lung. However, surgeons can also use it to aid diagnoses.

Other benefits of a pleurectomy include the following:

  • preventing the lungs from collapsing and making breathing easier
  • improving the quality of life for those with cancer by reducing shortness of breath, coughing and wheezing, and other symptoms
  • assisting with cancer removal and diagnosis

This surgery can cure some early cancers. Doctors may also recommend it as a palliative procedure to alleviate symptoms if they cannot remove the whole tumor.

The prognosis for people undergoing a pleurectomy depends on the underlying issue doctors are using the surgery to treat.

It usually does not cure the underlying condition. However, it may improve a person’s quality of life significantly.

Read on to find answers to some commonly asked questions about a pleurectomy.

Is a pleurectomy a major surgery?

Yes, a pleurectomy is a major surgery.

Surgeons typically conduct this procedure when a person is under general anesthesia. It can take several hours.

The recovery time for this type of surgery may be up to 8 weeks. After this time, a person should generally be able to return to work or resume their daily activities.

Can your lung collapse after a pleurectomy?

It is possible for the lung to collapse after a pleurectomy. The medical term for a collapsed lung is pneumothorax.

In a 2019 study, 20 out of 71 participants undergoing a P/D — 28.2% of the sample — experienced a pneumothorax.

Can a lung grow back after surgery?

A person’s lung will not regenerate after a surgeon has removed it.

Can you live without pleura?

Yes. Although the pleura is an important membrane, people can live without it.

The pleura is a thin, double-layered membrane that lines the inside of the chest cavity and covers the lungs. It provides a protective barrier between the lungs and chest wall and helps keep them separated.

A pleurectomy is a procedure where surgeons remove this lining to treat various conditions. It is a major surgery, and only some are eligible for this operation.