In our series, decortication was performed by creating a plane between the myocardium and the thickened peel, essentially performing an epicardiectomy. This procedure was accomplished with minimal bleeding. In one patient only, decorticated only 47 days after pneumonectomy (the earliest time interval in our series), we could not safely separate the fibrous tissue from the heart without causing bleeding, so decortication was limited to the inferolateral region of the myocardium. This inability to safely dissect the rind is most likely attributed to the time interval between pneumonectomy and decortication. We believe that inflammation was still active, because the tissue was highly vascularized and fibrin organization had not been completed. The patient subsequently relapsed and required reoperative decortication. All other patients were operated after a period of 2 months, usually between 2 to 4 months after pneumonectomy. This seems to be the appropriate timing, late enough to allow the inflammation to subside but also early enough to detect possible local metastasis. In the patient who experienced RV free-wall rupture, we believe that the RV decortication was likely too aggressive, and this, in addition to the absence of the epicardium (after decortication), weakened the RV free wall, making it susceptible to tearing. Therefore, on the right ventricle in particular, we suggest that decortication should be conservative.