Pleurectomy

Pleurectomy

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Pleurectomy is a type of surgery in which part of the pleura is removed. This procedure helps to prevent fluid from collecting in the affected area and is used for the treatment of mesothelioma, a pleural mesothelial cancer. [1] Pleurectomy provides symptomatic relief but does not appear to benefit survival rates.

Malignant pleural effusions generally result from metastatic spread of disease to the pleura and are commonly seen in the course of many tumors. Less frequently, effusions are associated with primary tumors of lung, pleura, or mediastinum.

Many nonsurgical methods have been proposed to control effusion and to improve respiratory function. Nonetheless, many studies have demonstrated the benefits of pleurectomy in patients with malignant effusions secondary to various cancers. [2]

Pleurectomy reduces the risk of symptomatic pleural effusions and recurrence of spontaneous pneumothorax. [3]

Pleurectomy is most commonly indicated for mesothelioma. However, other less common indications include the following:

Primary pneumothorax

Pneumothorax secondary to chronic obstructive pulmonary disease (COPD)

Traumatic pneumothorax

Malignant pleural effusions

Pleurectomy can be safely performed and effectively controls the symptoms of pleural effusion that develops with malignant pleural mesothelioma. The addition of postoperative phototherapy or intrapleural chemotherapy does not improve long-term survival, but pleurectomy does result in symptom palliation.

Martini N, Bains MS, Beattie EJ Jr. Indications for pleurectomy in malignant effusion. Cancer. 1975 Mar. 35(3):734-8. [Medline].

Ismail-Khan R, Robinson LA, Williams CC Jr, Garrett CR, Bepler G, Simon GR. Malignant pleural mesothelioma: a comprehensive review. Cancer Control. 2006 Oct. 13(4):255-63. [Medline].

Pleurectomy – What is a Pleurectomy lungcancer.about.com/od/glossary/g/pleurectomy.htm.

Roberts JR. Surgical treatment of mesothelioma: pleurectomy. Chest. 1999 Dec. 116(6 Suppl):446S-449S. [Medline].

Minatel E, Trovo M, Bearz A, Di Maso M, Baresic T, Drigo A, et al. Radical Radiation Therapy After Lung-Sparing Surgery for Malignant Pleural Mesothelioma: Survival, Pattern of Failure, and Prognostic Factors. Int J Radiat Oncol Biol Phys. 2015 Jun 20. [Medline].

Hountis P, Chounti M, Matthaios D, Romanidis K, Moraitis S. Surgical treatment for malignant pleural mesothelioma: extrapleural pneumonectomy, pleurectomy/decortication or extended pleurectomy?. J BUON. 2015 Mar-Apr. 20 (2):376-80. [Medline].

Burkholder D, Hadi D, Kunnavakkam R, Kindler H, Todd K, Celauro AD, et al. Effects of extended pleurectomy and decortication on quality of life and pulmonary function in patients with malignant pleural mesothelioma. Ann Thorac Surg. 2015 May. 99 (5):1775-80. [Medline].

Fahad Aziz, MD Academic Hospitalist, Department of Internal Medicine, Section on Hospital Medicine, Wake Forest University School of Medicine

Fahad Aziz, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Dale K Mueller, MD Co-Medical Director of Thoracic Center of Excellence, Chairman, Department of Cardiovascular Medicine and Surgery, OSF Saint Francis Medical Center; Cardiovascular and Thoracic Surgeon, HeartCare Midwest, Ltd, A Subsidiary of OSF Saint Francis Medical Center; Section Chief, Department of Surgery, University of Illinois at Peoria College of Medicine

Dale K Mueller, MD is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, American Medical Association, Chicago Medical Society, Illinois State Medical Society, International Society for Heart and Lung Transplantation, Society of Thoracic Surgeons, Rush Surgical Society

Disclosure: Received consulting fee from Provation Medical for writing.

Pleurectomy

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