Pleurectomy and Decortication
Pleurectomy and Decortication is a surgical procedure to treat mesothelioma. It is often performed with resection and reconstruction of the pericardium and the diaphragm.
This procedure is performed with a large incision in the chest. We remove a rib to allow entry into the chest cavity. The mesothelioma is separated from the chest wall, mediastinal structures, pericardium or heart sac, and the diaphragm. Often the pericardium and the diaphragm are resected and reconstructed with mesh. After the mesothelioma is separated from the surrounding structures, we remove it from the lung. Typically, we also remove the lymph nodes in the middle of the chest in a procedure called mediastinal lymph node dissection. Two or three chest tubes are placed in the area at the end of surgery to remove any air or fluid.
The main risks of this operation are bleeding, a prolonged air leak, pneumonia, and atrial fibrillation. With any operation, there is a risk of injuring any structure that we operate around including the major vessels, esophagus, heart, and airway. Other risks include infection at the site of surgery.
Hospital Stay: 5-7 Days
After the operation, the patient is admitted to the Intensive Care Unit (ICU) typically for 1 day. Once the patient recovers, he or she is transferred to the surgical floor. On average, patients are in the hospital for five to seven nights. Patients start a regular diet during the night of the surgery along with pre-emptive pain control with around the clock pain medication. Every day, the chest tube will be evaluated to determine if the tube can be safely removed. Once the patient’s chest tube is removed with good pain control, they are ready to continue the recovery at home.
We advise our patients to stay ahead of the pain with pre-emptive pain control. Instead of taking pain medication after having pain, we ask patients to take pain medication in regular intervals. The typical regimen for post-operative pain medication is:
3 days of Aleve (Naprosyn) 1 tab two times a day
5 days of Tylenol (Acetaminophen) 1 g three times a day
7 days of Neurontin (Gabapentin) 300 mg three times a day.
After 7 days, take Tylenol as needed. If this regimen is not adequate to control pain, we ask patients to call our office.
In order to further help with recovery from surgery, we advise patients to walk at least three times a day, work on the incentive spirometer, and sit in a chair for at least 6 hours a day for about a week after the surgery. We advise patients to avoid heavy lifting for 6 weeks. As long as the patient is not on narcotic pain medication, it is safe to drive.