PneumonectomyWhat 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 person's breathing capacity. Because of this, surgeons usually choose a less extreme form of lung surgery 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.
What It's Used For
Most often, a traditional pneumonectomy is done to remove lung cancer. A traditional pneumonectomy also may be necessary when a patient has been severely wounded in the chest.
An extrapleural pneumonectomy is sometimes a treatment option for certain people 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.
Preparation
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 the 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) 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 certain anti-inflammatory medications. If you take other blood-thinning medications, check with your doctor about when to stop them. On the night before your surgery, you must not eat or drink anything. The time of your last food or beverage depends on the scheduled time of your surgery.
How It's Done
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 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 replaced with patches 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 7 to 10 days after their surgery. The hospital stay for an extrapleural pneumonectomy may be one or two days longer.
Many centers now offer less invasive surgery called video-assisted thoracic surgery (VATS) for selected candidates. With VATS, the length of hospital stay may be reduced.
Follow-Up
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.
Recovery tends to be slow for most people. Even at six months after surgery, many pneumonectomy patients find that their ability to exercise is limited significantly because of shortness of breath.
Risks
Your thoracic surgeon will explain your personal risk. Short-term postoperative complications include:
- The need to be connected to a mechanical respirator for a prolonged period
- Heart problems, including cardiac arrhythmias and heart attack
- Pneumonia
- Wound infection
- A blood clot lodged in the lungs (pulmonary embolism)
- An abnormal connection between the stump of the cut bronchus and the pleural space (bronchopleural fistula)
- Pus accumulation in the pleural space (empyema)
- Fluid accumulation in the lungs (pulmonary edema)
- Kidney failure
One long-term risk is shortness of breath: Some people may require oxygen, which can be administered at home, for many months or even years after the surgery.
When To Call a Professional
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
Additional Info
National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: 301-592-8573
TTY: 240-629-3255
Fax: 301-592-8563
Email: nhlbiinfo@rover.nhlbi.nih.gov
http://www.nhlbi.nih.gov/
National Cancer Institute (NCI)
U.S. National Institutes of Health
Public Inquiries Office
Building 31, Room 10A03
31 Center Drive, MSC 8322
Bethesda, MD 20892-2580
Phone: 301-435-3848
Toll-Free: 1-800-422-6237
TTY: 1-800-332-8615
Email: cancergovstaff@mail.nih.gov
http://www.nci.nih.gov/
American Cancer Society (ACS)
1599 Clifton Road, NE
Atlanta, GA 30329-4251
Toll-Free: 1-800-227-2345
http://www.cancer.org/
American Lung Association
61 Broadway, 6th Floor
New York, NY 10006br />Phone: 212-315-8700
Toll-Free: 1-800-548-8252
Email: info@lungusa.org
http://www.lungusa.org/
