Pneumonectomy

What is a pneumonectomy?

A pneumonectomy is a surgery to remove your entire lung. Surgery to remove your entire right lung is a right-sided pneumonectomy, and surgery to remove your entire left lung is a left-sided pneumonectomy. Pneumonectomy is the most extensive type of lung resection (surgery). Other types include a lobectomy or wedge resection, which only removes parts of your lung.

During a simple, or standard, pneumonectomy, a surgeon removes your entire lung and sometimes, nearby nerves and tissue. During an extrapleural pneumonectomy, a surgeon removes your:

• Lung.
• Pleura (lining around your lung and chest wall).
• Pericardium (lining around your heart).
• Parts of your diaphragm (the muscle underneath your lungs).

Depending on your case, a surgeon can use a thoracotomy or video-assisted thoracic surgery (VATS) for a pneumonectomy. VATS is less invasive but not always an option.

What conditions does a pneumonectomy treat?

Providers mostly use a pneumonectomy to treat cancer in or around your lung, but they sometimes use it for other conditions. A pneumonectomy might be an option for:

• Lung cancer.
• Lung carcinoid tumors.
• Pleural mesothelioma.
• Certain lung injuries.
• Aspergillosis.
• Bronchiectasis.
• Tuberculosis.
• Disseminated thymoma.

When is a pneumonectomy needed?

While providers remove a lung to treat other diseases, pneumonectomy is most commonly used to treat lung cancer. You might be eligible for a pneumonectomy if:

• Your cancer is only in one lung (hasn’t spread) and could be cured by removing your lung.
• The tumor is in a place in your lung where a surgeon can’t remove it all without taking out your entire lung.
• Your heart, blood vessels and lungs function well enough to make you a good candidate for surgery.

You shouldn’t have a pneumonectomy if you have:

• Inadequate lung function.
• Severe heart valve disease.
• Severe pulmonary hypertension.
• Poor ventricular function (ability to pump blood to your body).

What happens before a pneumonectomy?

In the days or weeks before your surgery, your provider will perform several tests to determine how well your heart and lungs are working. These may include:

• VQ scan.
• Pulmonary function tests.
• Echocardiogram.
• Chest X-ray.
• PET scan.
• CT scan.
• Blood tests.

How should I prepare for a pneumonectomy?

Your provider will tell you how to prepare for your pneumonectomy. Some things you may need to do include:

• Arrange for someone to take care of your home or pets during your hospital stay.
• Arrange for someone to take you home when it’s time.
• Plan for any modifications to your home or daily schedule for when you come home from the hospital. For instance, you may need someone else to help you around the house or with errands for a while.
• Stop smoking. Ask your provider for resources to help you quit if you smoke.
• Give a list of medications to your provider. They may have you stop taking them or change when you take them before surgery. Don’t stop taking your medications as scheduled unless your provider tells you to.
• Let your provider know of any allergies to medications.
• Don’t eat or drink after midnight the day before your surgery.

What happens during a pneumonectomy?

The steps of a pneumonectomy might be different depending on whether your surgeon performs a thoracotomy or VATS. Generally, a provider will:

1. Have you lie on your side.
2. Give you general anesthesia to keep you asleep. They’ll monitor you for the entire procedure. You won’t feel pain or remember the procedure.
3. Prepare your skin, then make an incision (cut) in your side and back, between two ribs.
4. Separate your ribs to get to your lung. They’ll also have to delicately cut or move tissue and structures around your lungs (and your diaphragm, pleura and pericardium in the case of an extrapleural pneumonectomy).
5. Deflate your lung and remove it through the incision. They’ll remove any other structures and tissue, depending on the type of surgery.
6. Reconstruct your diaphragm or pericardium (if necessary).
7. Close your ribs, muscles and skin. They’ll cover the incision site with a surgical dressing.

Most of the time, surgeons don’t put a drain in for fluid during a pneumonectomy.

How long does a pneumonectomy take?

A pneumonectomy can take several hours. How long it takes depends on many factors, including whether it’s a right-sided or left-sided pneumonectomy. Because they’re more involved, extrapleural pneumonectomies take longer. Your surgeon can let you and your loved ones know how long they expect it to take.

What happens after a pneumonectomy?

After a pneumonectomy, you’ll stay in the hospital for several days. During this time:

• Your care team will monitor you closely with machines that track your oxygen levels, heart rate and blood pressure.
• You might receive oxygen through a tube under your nose.
• Providers will give you pain medication to keep you comfortable.
• Your providers may run blood tests, get imaging or do other tests and procedures to monitor your condition. This helps them determine when it’s safe for you to go home.
• Physical or occupational therapists may help you get out of bed and walk around or perform breathing exercises each day.

What fills the space after a pneumonectomy?

Immediately after a lung removal, air will fill the empty space. Eventually, fluid will replace the air. Over time, your heart, diaphragm, and other structures and organs shift toward the space. Your remaining lung may also expand some.

What are the benefits of a pneumonectomy?

In the case of cancer, a pneumonectomy may be a chance to remove the entire tumor and keep cancer from spreading. For other diseases or injury to your lung, removing a damaged lung can reduce your risk of fatal complications. These include empyema and bacterial or fungal infections.

What are the risks or complications of a pneumonectomy?

All providers involved in a pneumonectomy take precautions to reduce your risks. But pneumonectomy is a major surgery with a higher risk of complications than other types of resection that only remove a part of your lung. Some complications include:

• Empyema.
• Cardiac arrest.
• Infection.
• Pneumonia.
• Air leak in your chest cavity.
• Arrhythmia.
• Bronchopleural fistula (an abnormal connection between your large airways and spaces between the linings of your lungs).
• Hemothorax (chest cavity bleeding).
• Pulmonary embolism.
• Reactions to anesthesia.
• Vocal cord paralysis.
• Respiratory failure.
• Postpneumonectomy syndrome. If your organs shift too much after having your lung removed, it can stretch your remaining lung and esophagus and block your airways. This can happen years after surgery.
• Cancer recurrence despite surgery. Even though your surgeon removes all visible tumors, sometimes, cancer can come back in other places.

Because of anatomical differences, right-sided pneumonectomies have a higher risk for complications than left-sided.

What is the recovery time for a pneumonectomy?

It can take several months to fully recover from a pneumonectomy. During that time, you may:

• Have restrictions on activities you can do, such as driving or lifting.
• Feel more tired than usual.
• Need to take frequent breaks.
• Be unable to do daily activities the way that you’re used to.
• Have frequent discomfort.

All of these things might affect your ability to return to work or school. Some of these changes are temporary as you recover, and some may be a “new normal” that requires adjustment.

How can I make my recovery easier?

Recovering from major surgery and living with one lung are both challenging. To help you recover:

• Follow your provider’s directions on what to do and not do while you recover. Activities like lifting heavy objects while you’re still healing can cause serious injuries.
• Keep up with any exercise, physical therapy or breathing treatments your provider prescribes.
• Take all medications as directed.
• Keep all of your scheduled follow-up appointments.
• Contact your provider with any questions or concerns.

What is life expectancy with one lung?

How long you can survive after a pneumonectomy depends on a number of factors, including:

• Why you had a pneumonectomy. For instance, more than 3 out of 4 people with tuberculosis who have a pneumonectomy survive 10 years after surgery. But recent studies suggest that about 1 in 3 people who have a pneumonectomy for non-small cell lung cancer are alive five years later.
• Whether you have other treatments for your condition. Depending on your specific situation, additional treatments can improve your prognosis. But they can also increase the risk of complications.
• Whether you had a right-sided or left-sided pneumonectomy. People who have a left-sided pneumonectomy have a better prognosis than people who have a right-sided pneumonectomy.

What is the quality of life after removing a lung?

Your quality of life after pneumonectomy depends largely on why you needed one (the underlying illness). Other factors can also play a role in your quality of life. For instance, people over 70 tend to have a harder time adjusting after a pneumonectomy than people under 70.

When should I call my healthcare provider?

Contact your provider if you have any questions or concerns before your surgery or during recovery. Call them right away if you have these symptoms:

• Blood soaking through your incision bandage.
• Discolored fluid or fluid that smells bad around your incisions.
• A cough with a lot of mucus or discolored mucus.
• Fever.
• Nausea or vomiting.
• Pain that medication doesn’t help.

Call 911 or go to the nearest emergency room if you have these symptoms:

• Coughing up blood.
• Severe trouble breathing.
• Sudden chest pain with shortness of breath.
• Passing out/losing consciousness.

What questions should I ask my healthcare provider?

It might be helpful to ask your provider:

• Are there any alternatives to a pneumonectomy?
• What happens if I don’t have surgery?
• How long will recovery take?
• Will I be able to return to work?
• What instructions should I follow before surgery?
• What complications should I look out for?
• How do I take care of myself at home?

A note from Cleveland Clinic

While many people can live with one lung for a long time, pneumonectomy is a complex surgery with a long recovery time. Surgeons only consider it if there are few or no other treatment options and they think you’re healthy enough to have a lower risk of complications.

Just as all surgeries carry risks, not having surgery has certain risks, too. Ask your healthcare provider about both. Discussing your wishes for your health and your future honestly with your provider and your loved ones can help you decide what the best option is for you.