The pleurectomy / decortication is considered the least radical of the two approaches since it only involves the removal of the pleura (lining of the lung) without removing the lung beneath. In some cases, the pericardium and diaphragm must be removed, depending on the size of the tumor. The advantages of this procedure is a recovery time usually faster, and utility for patients who may not be able to tolerate more radical PPEP. The disadvantages include an increased risk of disease recurrence due to the inability to remove the whole tumor and the inability to use high doses of adjuvant radiation because of potential damage to the underlying lung.

The extrapleural pleuropneumonectomy is a more radical procedure that involves removing the lung, pleura (lining of the lung), the pericardium surrounding the heart and part of the diaphragm. During surgery, the pericardium and diaphragm were reconstructed with a material similar to Gortex. To be eligible for this surgery, patients must meet certain criteria and demonstrate stage pulmonary and cardiac functions appropriate to be able to withstand the procedure.