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Decortication is a term which is used to refer to the removal of a rind or peel. In a medical context, the term means removing the fibrous outer layer of tissue which covers an organ. Most typically, decortication is used in the management of certain lung conditions, most notably in tuberculosis and mesothelioma. People have been using this technique since the 20th century, and it is important to note that it is a palliative measure, not a treatment or cure.
In decortication of the lung, the most common form of this procedure, the patient is placed under general anesthesia and the chest cavity is opened. The surgeon identifies areas of the pleural membrane which have become fibrous and scarred, and removes them. Then, the surgical site is closed and the patient is brought out of anesthesia. This surgery is major and quite invasive, and requires several days of monitoring in the hospital after the surgery is complete to confirm that a patient is healing well.
Lung decortication is commonly performed because thickening of the pleura is causing pain or discomfort for the patient. If the thickening progresses enough, it can lead to difficulty breathing, because the involved lung may have difficulty reinflating since it cannot push the pleura out of the way. This can lead to shortness of breath and a cascade of other medical issues as the patient struggles with lack of oxygen.
This procedure may be recommended to increase patient comfort or to address immediate breathing problems. In the long term, measures need to be taken to address the reason that the membrane thickened in the first place. In cases of cancer, for example, radiation can be used to shrink the tumor, and if it is feasible to do so, a surgeon can remove the growth of rogue cells. It is important to address the underlying cause once the patient has been made comfortable.
Decortication surgery is not a procedure to take lightly. Patients should discuss the reasons that the surgery is being recommended with their physicians, and they should make sure that they understand the potential benefits and risks. It is also advisable to ask about aftercare instructions, including those related to the use of prophylactic medications to prevent infections. Something to consider for patients who are terminal and are thinking about focusing on palliative care is whether or not they want to go through the surgery, given their conditions. Each case is different, and a doctor can provide information and advice specific to unique circumstances.