pleurectomy

Pleurectomy is a thoracic surgical procedure in which part or all of the pleura—the serous membranes lining the chest cavity (parietal pleura) and covering the lungs (visceral pleura)—is removed. It is used to manage conditions that involve the pleural space, including recurrent pleural effusions, trapped or non-expanding lungs, empyema, and certain pleural malignancies such as mesothelioma. Pleurectomy is distinct from pleurodesis, which aims to obliterate the pleural space by inducing adhesion of the pleural surfaces without removing the pleura.

Techniques vary from partial or apical pleurectomy to total pleurectomy, and may be performed via video-assisted thoracoscopic surgery (VATS) or open thoracotomy. In some cases, pleurectomy is combined with decortication, resulting in pleurectomy with decortication, to remove both the pleura and the fibrous rind restricting the lung, particularly in mesothelioma or organized empyema. An extended pleurectomy may be used to achieve better lung re-expansion and palliation.

Indications include malignant effusion or pleural tumors, recurrent parapneumonic effusions, empyema with loculations, and select cases of persistent pneumothorax (apical pleurectomy). The choice of approach depends on disease extent, patient factors, and goal of surgery (palliation versus potential cure).

Outcomes vary with underlying disease. In malignant effusions or mesothelioma, pleurectomy can provide symptom relief and, in some cases, contribute to disease control. Risks include prolonged air leak, bleeding, infection, pain, and impaired pulmonary function. Recovery typically involves chest tube management and postoperative rehabilitation.