Pleurectomy and decortication remove restrictive or diseased pleural tissue
Decortication peels dense tissue from the lung so it can re-expand, often after organized infection. Pleurectomy removes diseased parietal pleura and may be part of selected mesothelioma treatment.
The terms cover operations with very different extent. The team must state whether surgery is for infection, trapped lung, recurrent air leak, symptom relief or macroscopic tumor reduction.
For pleural cancer, surgery is usually part of multimodality care and may not remove microscopic disease; for empyema, source control and lung expansion are central.
Who may be considered?
Specialist review may help when the diagnosis, symptoms and previous treatment create a focused question about pleurectomy and decortication.
- Organized empyema with a trapped lung despite drainage and antibiotics.
- A symptomatic fibrous pleural peel preventing expansion.
- Selected pleural mesothelioma within an experienced multidisciplinary programme.
- Recurrent pleural disease requiring operative control in carefully assessed cases.
What the specialist team must confirm
The team reviews contrast CT or PET, pleural pathology and microbiology, drain history, lung expansion, pulmonary reserve, infection activity, cancer stage, diaphragm and chest-wall involvement and whether complete macroscopic resection is realistic.
Key points for this treatment

From pleural diagnosis to lung re-expansion or cytoreduction
The operation is justified only when its physiologic or symptom goal is clear and less-invasive drainage or systemic treatment is insufficient.
Drains and lung expansion shape recovery
Multiple chest drains may remain while air and fluid output settle. Pain control and respiratory physiotherapy support expansion of a lung that may have been compressed for weeks.
For infection, cultures and antibiotics guide follow-up. For cancer, pathology and remaining disease determine systemic therapy, radiation or surveillance.

Risks, limits and realistic expectations
Risks include major bleeding, prolonged air leak, pneumonia, empyema, respiratory failure, diaphragm or nerve injury, incomplete lung expansion, persistent pain, recurrent pleural disease and death.
Worsening breathlessness, fever, purulent drainage, coughing blood, fainting or rapidly increasing chest pain requires urgent local care.
