Pneumonectomy

What is a pneumonectomy?

A pneumonectomy is surgery to remove one of your lungs because of cancer, injury, or some other condition.

You have 2 lungs: a right lung and a left lung. These lungs connect to your mouth and nose through a series of tubes or airways. Through these tubes, the lungs bring oxygen into the body and remove carbon dioxide from the body. Oxygen is needed for all functions of your body. Carbon dioxide is a waste product that the body needs to get rid of. Most people can get by with only 1 lung instead of 2, if needed. Often 1 lung can provide enough oxygen and remove enough carbon dioxide, unless the other lung is damaged and can't do this function.

During a pneumonectomy, the surgeon makes a cut (incision) on the side of your body. The surgeon cuts some muscle and spreads the ribs apart. They surgically remove the affected lung. The sac that contains the lung (the pleura) fills up with air. Over time, fluid takes the place of this air.

In rare cases, healthcare providers may do a pneumonectomy with a VATS (video-assisted thoracoscopic surgery) procedure instead. This procedure uses a special video camera at the end of a thin tube called a thoracoscope. It's a type of minimally invasive surgery. That means it uses smaller cuts than the larger traditional open surgical incision done on the lung. In cancer treatment, most pneumonectomy experts advise 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 technical skill and experience.

Why might I need a pneumonectomy?

Lung cancer is the most common reason for a pneumonectomy. Healthcare providers often try to remove as little as possible of the lung tissue. You might need this procedure if a smaller surgery would not be able to remove all of the cancer. Some cancers located near the center of the lung also need this procedure instead of a smaller surgery.

Sometimes a pneumonectomy is also needed for other lung diseases. Some of these include:

• Traumatic lung injury

• Advanced pulmonary tuberculosis

• Fungal infections of the lung

• Bronchiectasis

• Congenital lung disease

• Bronchial blockage with a destroyed lung

What are the risks of a pneumonectomy?

Many people who have this surgery do very well. But it is a fairly high-risk surgery. Some possible complications are:

• Respiratory failure

• Blood clot in the lung (pulmonary embolism)

• Pneumonia (lung infection)

• Shock

• Complications from anesthesia

• Too much bleeding

• Abnormal heart rhythms

• Reduced blood flow to the heart

Your recovery will probably take weeks or even months. If the surgeon spreads your ribs to get to the lung, the area near the incision will hurt for some time after surgery. Your overall activity may be limited for 1 to 2 months. If you have emphysema or chronic bronchitis (common diseases among smokers), you might become more short of breath with certain activities.

Your age, any other health problems, and other factors will help determine your risk for complications. Before your surgery, ask your healthcare provider about your specific risks.

How do I get ready for a pneumonectomy?

Ask your healthcare provider about what you need to do to get ready for your pneumonectomy. In general:

• Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as aspirin and all prescription medicines. It also includes herbs, vitamins, and other supplements. You may need to stop taking some medicines before the surgery, such as blood thinners. Do not stop taking any medicines unless your provider asks you to do so.

• If you smoke, you need to quit before your surgery. Ask your healthcare provider for resources to help you.

• Tell your provider if you have any allergies, including a latex allergy.

• Tell your provider if you’ve ever had a reaction to local or general anesthesia.

• Daily exercise is an important part of getting ready for surgery. Ask your healthcare provider what kind is best for you.

• You might need to do breathing exercises with a device called a spirometer.

• Follow all directions you are given about not eating or drinking before your surgery. Ask if you can take your medicines with sips of water during this time.

• Any hair on or around the surgery site may be removed before the procedure.

You may also need 1 or more of these tests:

• Chest X-ray. This looks at the heart and lungs.

• Chest CT scan. This imaging test provides more detailed pictures of the lungs.

• PET scan. This is done to look for cancer tissue.

• Electrocardiogram (ECG). This test looks at your heart rhythm.

• Pulmonary function tests. These tests can see how well your lungs are working.

• Ventilation-perfusion scan. This helps figure out which areas of the lung contribute most to breathing.

• Blood tests. These are done to check your overall health.

What happens during a pneumonectomy?

Ask your healthcare provider about what to expect during your pneumonectomy. The following is a general description of the most common approach. This procedure may differ if your healthcare provider is using minimally invasive surgery. In general:

• You will lie on your side on an operating table with your arm above your head.

• You may get antibiotics to help prevent infection.

• You will get general anesthesia before the surgery starts. It will put you into a deep sleep so you don’t feel any pain during the procedure.

• The surgery will take several hours.

• The surgeon makes a cut several inches long between 2 ribs. The cut will go from under your arm to around your back, on the side of the lung that is being removed.

• The surgeon separates 2 ribs. In some cases, the surgeon might remove a small part of the rib.

• The surgeon deflates the affected lung and removes it.

• The surgeon may remove some nearby lymph nodes. These may help show the spread of the cancer and how advanced a cancer might be.

• Your surgeon will close the ribs, the muscles, and the skin. A dressing will be applied over the incision.

• Most of the time, a chest tube is left in the pleural space from where the lung was removed. This is removed when your condition improves.

What happens after a pneumonectomy?

Ask your healthcare provider about what to expect. In general:

• When you wake up, you might feel confused at first. You might wake up a couple of hours after the surgery, or a little later.

• Your vital signs will be carefully watched. These include your heart rate, breathing, blood pressure, and oxygen levels. You will have several types of monitors attached to help monitor your condition.

• You may get oxygen through small tubes placed in your nose. This is usually short-term (temporary).

• You will feel some soreness and pain. But you shouldn’t feel severe pain. If you need it, pain medicine is available.

• You will likely need to do special breathing treatments to help keep your airways open several times a day.

• If you have a chest tube in place, it will be watched. It will be removed before you go home. A dressing will be put over the site.

• You may wear special stockings (compression stockings) on your legs to help prevent blood clots.

• You will need to stay in the hospital for several days.

After you leave the hospital:

• Make sure you have someone to drive you home. You will also need some help at home for a while.

• You will have your stitches or staples removed in a follow-up appointment. Be sure to keep all of your follow-up appointments.

• You may tire easily after the surgery. But you will slowly start to recover your strength. It may be several weeks to a month before you fully recover.

• You may need to do breathing exercises using a spirometer.

• You need to be up and walking several times a day.

• Ask your healthcare provider when it will be safe for you to drive.

• Don't lift anything heavy for several weeks.

• Follow all the instructions your healthcare provider gives you for medicine, exercise, diet, and wound care.

• Call your healthcare provider right away if you have any signs of infection, fever, swelling, shortness of breath, or pain that is getting worse. A small amount of drainage from your incision is normal.

• Call your healthcare provider if you have any questions. Know what number to call for your provider after office hours, including weekends and holidays. Always ask if you have any questions about how to take your medicine or if you are worried about any symptoms.

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure