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Mesothelioma Treatments: Palliative Surgery - Decortication of the Lung

A decortication is a surgical procedure that removes the surface layer of an organ. In the case of the lung, decortication refers to the removal of the visceral pleura that encases it. When used for palliative purposes, the procedure is most commonly performed for patients with some form of trapped lung syndrome, where disease and/or tissue structure collapse prevents the lung from fully expanding, causing pain and breathing problems to the affected patient.

Decortication can also be performed with curative intent. When this is the case, a decortication is performed with a simultaneous parietal pleurectomy to remove all of the pleural tissues and possibly some extrapleural tissues as well, with the end goal being the removal of all malignant tissue. To learn more about the use of pleurectomy-decortication for the curative treatment of pleural mesothelioma, please read our article Mesothelioma Treatment: Curative Surgery - Pleurectomy-Decortication.

Decortication of the Lung – Overview of the Procedure

The goal of a decortication of the lung is an increase in vital lung capacity. When pleural mesothelioma affects the visceral pleura, the pleura no longer features the same elasticity it once did. Instead, mesothelioma creates a sheath-like structure of tumors on its surface that restricts lung expansion in a progressively more limiting manner. Decortication of the lung has been associated with a significant increase in lung capacity, but studies have not shown any long-term benefit to the procedure.

Decortication is a delicate operation and must be carried out in an especially safe manner, as the visceral pleura’s attachment to the lung increases the chances of lung damage during resection. To maximize lung capacity, the surgeon must remove as much of the pleura as possible and then must drain the area of the fluid associated with the trapped lung and of any pus that has adhered to the lung after resection. Thoracotomy has been the standard technique for decortication because it gives the surgeon maximum exposure to the pleural cavity, as well as an open an area in which to move around, but many surgeons are now experimenting with VATS for lung decortication.

Decortication can be performed as a precursor stage to a pleurodesis, and the combination of the two often represents more effective control of pleural effusions than a simple pleurodesis alone.

Decortication of the Lung – Treatment Considerations

As we said above, decortication has traditionally been completed through a thoracotomy, but the possibly significant side effects associated with it may limit the patients eligible to receive palliative decortication. The initial results from the surgeons who are using VATS to decorticate the lung have been promising, but few long-term studies have been completed, so questions still remain on the overall efficacy of the technique. That said, for patients who are not able to undergo a decortication through thoracotomy, VATS represents a real chance at effective palliation.

Decortication of the Lung – Conclusion

A successful decortication can have significant benefits to patients with pleural mesothelioma, but patient selection and choice of procedure is crucial to determine who is a good candidate for the surgery and who is not. Mortality rates from the procedure itself are rather low, but any increase in overall survival is rarely noted, so only those patients who may really benefit from successful palliation are generally considered eligible for decortication of the lung.

Related Information: Mesothelioma & Surgery

For more information related to the surgical treatment of mesothelioma, please read the following:

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