Pneumonectomy is a surgical procedure that removes the lung in its entirety. It is performed as a treatment for cancer, certain other lung conditions, and trauma.
The lungs consist of two large organs within the chest cavity whose main function is to get oxygen into the blood while removing carbon dioxide. The lungs also provide protection from harmful airborne substances such as smoke, pollution, bacteria, and viruses by trapping them in the mucus (sticky fluid produce by the lungs), which is then expelled from the body by coughing or swallowing.
When one lung is damaged, the other lung can provide enough oxygen and remove enough carbon dioxide. However, because pneumonectomy removes half of a person’s breathing capacity, physicians usually choose a less extreme form of lung surgery, if possible, removing only the affected portion.
Still, a pneumonectomy probably is the best option when a tumor is located in the middle of the lung or involves a significant portion of the pulmonary artery or veins, and a smaller surgery would not be able to remove the cancer.
Pneumonectomy may be recommended for the treatment of some cancers, such as lung cancer, pulmonary metastases (cancer that has spread to the lungs from another site in the body) or malignant mesothelioma (cancer of the pleura or the membrane lining the chest cavity and covering the lungs).
Pneumonectomy also may be recommended in non-cancerous or benign conditions, such as a traumatic lung injury, fungal lung infection, bronchial obstruction with destroyed lung, congenital lung disease, and lung infections such as tuberculosis.
Types of pneumonectomy
There are two types of pneumonectomy
- Traditional/standard pneumonectomy
This approach removes the entire diseased lung. A traditional pneumonectomy is usually performed to remove lung cancer. It also may be necessary when a patient has been severely wounded in the chest.
- Extrapleural pneumonectomy
During this procedure, the entire diseased lung is removed together with a portion of the membrane that covers the heart (the pericardium), a portion of the diaphragm, and the membrane that lines the inside of the chest (the pleura). An extrapleural pneumonectomy may be a treatment option for malignant mesothelioma, which is a cancer of the pleura that is typically caused by exposure to asbestos.
Preparing for surgery
Before surgery, the patient will have a series of imaging scans and blood tests. These tests will confirm that the cancer has not spread outside the lungs, that the remaining lung is healthy enough to compensate, and that the heart is strong enough to withstand the surgery. The scans may include a bone scan, computed tomography (CT) scan of the chest, positron emission tomography (PET) scan, and ventilation-perfusion scan (to find the areas that contribute most to breathing). The doctor also will review the patient’s allergies and medical history. About one week before surgery, the patient is advised to stop taking aspirin and certain anti-inflammatory medications. The night before the surgery, the patient is advised not to eat or drink.
How pneumonectomy is done
A pneumonectomy is generally performed using a thoracotomy. During a thoracotomy, a surgical incision is made between two ribs, extending from the front of the chest to the back. The deflated lung is then removed, and perhaps other organs or tissue, too, depending on the type of pneumonectomy being performed.
In rare cases, healthcare providers may perform a pneumonectomy using a video-assisted thoracic surgery (VATS) procedure. This procedure uses a special video camera called a thoracoscope. It is a type of minimally invasive surgery and uses smaller incisions than the traditional open surgery performed on the lung. In cancer treatment, most pneumonectomy experts recommend VATS only for people with early-stage tumors that are near the outside of the lung. This complex procedure requires a surgeon with a great deal of training, technical skill and experience.
Risks associated with pneumonectomy
Many people who have a pneumonectomy do very well, but it is still a high-risk surgery. There are several risks and side effects associated with undergoing a pneumonectomy. Some possible complications include dependence on a mechanical respirator for a prolonged period of time, respiratory failure, blood clot in the lung (pulmonary embolism), pus accumulation in the pleural space, fluid accumulation in the lungs, pneumonia, shock, complications from anesthesia, kidney failure, excessive bleeding, wound infection, abnormal heart rhythms, and reduced blood flow to the heart.
Recovery may take several weeks, or even months. Overall activity may be limited for one to two months. If the patient has other lung conditions, such as emphysema or chronic bronchitis (common diseases among smokers), shortness of breath may become worse with certain activities.
The patient’s age and other factors, such as health problems, may help to determine the risk of complications.
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