Pneumonectomy

What is a 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 there is damage to the remaining lung.

During a pneumonectomy, the surgeon makes an 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.

Rarely, 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.

Why might I need a pneumonectomy?

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.

Occasionally, 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 obstruction with a destroyed lung
  • Pulmonary metastases. This is cancer that has spread to the lungs from another site in the body.

What are the risks of pneumonectomy?

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
  • Excess bleeding
  • Abnormal heart rhythms
  • Reduced blood flow to the heart

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:

  • You may need to stop taking certain medicine before the surgery, like anticoagulation medicines (blood thinners). Talk with your healthcare provider about all the medicines you take, including over-the-counter medicines.
  • If you smoke, you need to quit before your surgery. Ask your healthcare provider for resources to help you.
  • 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.
  • You should avoid eating or drinking anything after midnight 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, to look for cancer tissue
  • Electrocardiogram, to look at the heart rhythm
  • Pulmonary function tests, to see how well your lungs are working
  • Blood tests, to check 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 will probably get antibiotics to help prevent infection.
  • You will get anesthesia before the surgery starts. It will cause you to sleep deeply and painlessly during the operation. Afterward, you won’t remember it.
  • The operation will take several hours.
  • The surgeon makes a cut several inches long between two 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 two 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.

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, such as your heart rate, breathing, blood pressure, and oxygen levels, will be carefully watched. 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 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 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 gradually start to recover your strength. It may be several weeks 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.

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 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

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