The pleurae are membranes that surround the lungs. One membrane is attached to the outer wall of the chest and the other is attached to to the lung. Between the membranes is a small space called the pleural cavity and it contains a minute amount of fluid that is produced by the pleura. This fluid is similar to the composition of plasma. This fluid allows the lungs and other organs to slide easily against each other. Also, it serves to keep the lungs air tight.
A healthy person normally should have no more than 1 ml of fluid in each pleural space. The fluid is created and enters the pleural through small capillaries. Fluid is removed by means of the lymphatics by absorbing excess fluid. It is by the production of too much fluid or the lack of absorption that then creates in imbalance or pleural effusion. There many possible causes for this condition, including mesothelioma.
Since there are numerous causes of pleural effusion, a family history, a physical examination and a chest x-ray is needed. These will establish the condition and will also allow the proper identification of the type of effusion. There are two types: 1) Transudative (caused by systemic factors) and 2) Exudative (caused by local factors). The physician may then require a fluid analysis. This will assist in determining the cause of the fluid build up. The fluid analysis will involve the following:
- Chemical composition
- Gram stain and culture
- Cell count and differential
- Cytology, for cancer or infection
Sometimes treatment is required and other times not. One such treatment is through a process known as decortication.
Decortication involves the surgical removal of the pleural membrane or the fibrous covering of a body organ, such as the kidney, brain or lung. Most commonly the decortication procedure is used with the lung due to pleurisy or infection. Treatment of mesothelioma often includes removal of the membrane in the pleural cavity.
Pleurectomy/decortication is usually a palliative procedure, meaning it simply relieves the symptoms and not the actual disease, as in cancer cases. Decortication would be performed especially when a complete removal of a tumor is not likely. Thus the decortication would remove the pleura that is mostly effected by the tumor. This procedure would control any possible fluid build up and thus make the patient much more comfortable by improving their breathing and decreasing pain.
General anesthesia is required for a decortication and the procedure is considered major thoracic surgery. An incision is required to gain access to the affected area.
Another option for surgeons is a thoracotomy, an open surgical procedure that is much more complicated than decortication. Thoracotomy requires a surgical incision into the chest and is much more invasive.
Decortication Post-Operative Care
After surgery, the patient will likely remain in the hospital for up to a full week during initial recovery. Total recovery may take between four and six weeks. Frequently, doctors prescribe a post-surgical regiment of chemotherapy or radiation treatment to serve as complementary treatments to the decortication.
During the initial month of recovery, oncologists will likely encourage the patient to engage in routine breathing exercises and undemanding physical activity. The purpose of this is to improve chest mobility and reduce the possibility for infection.
Decortication is not without its risks. Though unlikely, serious complications can occur. For example, damage caused to lung tissue underlying the thin pleura is a possibility. Complications may also arise related to blood loss or breathing obstructions.
Even when taking these complications into account, the majority of oncologists will recommend this procedure if it is deemed to be effective. Compared to alternative radical procedures – such as extrapleural pneumonectomy – decortication exhibits lower mortality rates due to surgery.