Pneumonectomy

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

You have two lungs: a right lung and a left lung. These lungs connect to your mouth through a series of tubes. Through these tubes, the lungs bring oxygen into the body and remove carbon dioxide from the body. Oxygen is necessary 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 one lung instead of two, if needed. Usually, one lung can provide enough oxygen and remove enough carbon dioxide, unless the other lung is damaged.

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. He or she surgically removes the affected lung. The sac that contained the lung (pleural space) fills up with air. Eventually, fluid takes the place of this air.

In rare cases, healthcare providers may do a pneumonectomy with a VATS procedure instead. This procedure uses a special video camera called a thoracoscope. It is a type of minimally invasive surgery. That means it uses smaller incisions than the traditional open surgery done 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 technical skill and experience.

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

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

• Traumatic lung injury
• Pulmonary tuberculosis
• Fungal infections of the lung
• Bronchiectasis
• Congenital lung disease
• Bronchial blockage with a destroyed lung
• Pulmonary metastases (cancer that has spread to the lungs from another site in the body)

Many people who have a pneumonectomy 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
• 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 spread 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.

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

• Tell your 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.

• 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 latex.
• 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.

• Don’t eat or drink after midnight the night before your surgery.

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

You might also need one or more of the following tests:

• Chest X-ray, to see the heart and lungs
• Chest CT scan, to get more detailed pictures of the lungs
• Positron emission tomography (PET) scan, to look for cancer tissue
• Electrocardiogram (ECG), to look at your heart rhythm
• Pulmonary function tests, to see how well your lungs are working
• Ventilation-perfusion scan, to figure out which areas of the lung contribute most to breathing
• Blood tests, to check your overall health

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 will probably get antibiotics to help prevent infection.
• You will get 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 how advanced a cancer might be.
• Your surgeon will close the ribs, the muscles, and 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.

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 with monitoring your condition.
• You may get oxygen through small tubes placed in your nose. This is usually short-term (temporary).
• You will feel some soreness. But you shouldn’t feel severe pain. If you need it, pain medicine is available.
• You may do breathing therapy to help remove fluids that collect in your lungs during surgery. You will probably need to do this several times a day.
• 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 need to be up and walking several times a day.
• Ask your healthcare provider when it will be safe for you to drive.
• Avoid lifting 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, or pain that is getting worse. A small amount of drainage from your incision is normal.
• Call your provider if you have any questions. Always ask if you have any questions about how to take your medicine or you are worried about any symptoms.

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 will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure