What Is It?

A pneumonectomy is the surgical removal of a lung, usually as a treatment for cancer. It can be done in one of two ways:

• Traditional pneumonectomy — Only the diseased lung is removed.
• Extrapleural pneumonectomy — The diseased lung is removed, together with a portion of the membrane covering the heart (pericardium), part of the diaphragm and the membrane lining the chest cavity (parietal pleura) on the same side of the chest.

Pneumonectomy removes half of a patient’s breathing capacity. Because of this, surgeons usually choose a less extreme form of lung surgery in cancer patients if possible. However, a pneumonectomy is probably the best option when a tumor is located in the middle of the lung and involves a significant portion of the pulmonary artery or veins.

Most often, a traditional pneumonectomy is done to remove lung cancer. A traditional pneumonectomy also may be necessary when a patient has been wounded severely in the chest.

An extrapleural pneumonectomy is sometimes a treatment option for certain patients with a type of cancer called malignant mesothelioma. Malignant mesothelioma is a cancer of the pleura (the membrane lining the chest cavity and covering the lungs) that typically is caused by exposure to asbestos.

If you need a pneumonectomy to treat lung cancer or malignant mesothelioma, your doctor will order extensive testing of your lungs before your surgery to confirm that your remaining lung is healthy enough to take over the entire workload of breathing for your body. You also will have tests to make sure your heart is strong enough to withstand the stress of surgery.

Before your surgery is scheduled, you will have a series of scans and blood tests to confirm that the cancer has not spread (metastasized) to areas of your body outside your lungs. These scans may include a bone scan, a computed tomography (CT) scan of your abdomen and a CT scan of your head. Your doctor also will review your allergies and your medical history.

About one week before surgery, you will be told to stop taking aspirin and other blood-thinning medications. Beginning at midnight on the night before your surgery, you must not eat or drink anything. This reduces the risk of vomiting during surgery.

An intravenous (IV) line will be inserted into a vein in your arm to deliver fluids and medications, and you will be given general anesthesia. An incision will be made in your chest on the side of the diseased lung. In most cases, the incision extends from below your shoulder blade, around your side, along the curvature of the ribs, to the front of your chest. The surgeon also may remove a portion of one rib to help to expose the lung and to give him or her enough working space.

Next, in a traditional pneumonectomy, the surgeon collapses the diseased lung and ties off its major blood vessels. Then the surgeon clamps the lung’s main bronchial tube (air tube), cuts through this tube as close to the trachea (windpipe) as possible and removes the lung. The cut end of the bronchial tube either is closed with staples or tied off with sutures (stitches). After confirming that the closed end of the bronchial tube is not leaking air, the surgeon closes the chest incision with sutures, leaving a temporary drain in the pleural space, the space between the two membranes that surround the lung.

If you are having an extrapleural pneumonectomy, the surgeon not only will remove your diseased lung, but also will carefully remove the pleura from your chest wall. Parts of your pericardium and diaphragm will be cut away on the affected side, and these will be replaced with patches made of Gore-Tex, a safe, synthetic material.

After your surgery, you will be taken to the surgical intensive care unit (ICU). For the first 24 hours, your breathing will be assisted with a respirator, and your chest drainage tube will remain in place. Once your condition is considered stable, usually within a few days, you will leave the surgical ICU and be transferred to a regular hospital room. Most patients who have had a traditional pneumonectomy will be able to go home seven to 10 days after their surgery. The hospital stay for an extrapleural pneumonectomy may be one or two days longer.

Less-invasive treatments are being developed as alternatives to traditional pneumonectomy. These include:

• The use of video-assisted thoracic surgery, which has reduced the hospital stay to an average of seven days
• A minimally-invasive approach (without video-assisted thoracic surgery), which has dramatically shortened the hospital stay to one day

These innovative techniques are exciting, but they are not yet accepted as standard procedures that can be performed on the majority of pneumonectomy patients.

Before you are discharged from the hospital, your surgeon will tell you when you should schedule your first follow-up visit. As you gradually resume your normal daily activities, your remaining lung will slowly compensate for the loss of its partner.

Overall, recovery tends to be slow for most patients. Even at six months after surgery, about 60 percent of pneumonectomy patients find that their ability to exercise still is limited significantly because of shortness of breath.

Pneumonectomy is a risky procedure. However, this major operation is necessary for some people because it offers the best chance of a cancer cure. Your thoracic surgeon will explain your personal risk. Short-term postoperative complications affect 40 percent to 60 percent of patients who have had a pneumonectomy. Some of these complications include:

• The need to be connected to a mechanical respirator for a prolonged time
• Heart problems, including cardiac arrhythmias and heart attack
• Pneumonia
• Wound infection
• A blood clot lodged in the lungs, called a Pulmonary embolism
• An abnormal connection between the stump of the cut bronchus and the pleural space, called a bronchopleural fistula
• Pus accumulation in the pleural space (empyema)
• Fluid accumulation in the lungs (pulmonary edema)
• Kidney failure

A long-term risk is that some patients will remain very short of breath after the surgery and require oxygen that can be administered at home.

After your discharge, call your doctor immediately if:

• You develop chest pain cough, or shortness of breath.
• You have a fever.
• Your incision becomes red, swollen and painful, or it oozes blood.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.