Definition & Overview

Pneumonectomy is a major surgical procedure that involves the removal of the entire lung in cases of lung cancer, lung tumor, benign lung diseases, or major damage to the main air passage or lung blood vessels due to trauma or injury.

There are two techniques used for lung removal and both involve opening the chest area. In a standard pneumonectomy, the surgeon removes either the entire right or left lung, depending on the location of the malignancy or injury. The other technique is more extensive and is called extrapleural pneumonectomy. It involves the removal of an entire lung, along with a part of the diaphragm, a part of the pericardium, and the membrane that lines the chest cavity.

Who Should Undergo & Expected Results

Pneumonectomy is often recommended as the last resort for those diagnosed with lung cancer, particularly those whose condition no longer responds to other types of therapy. It is also considered a viable option if the cancer has spread to more than one lobe of the lung.

Lung removal is also advised for the treatment of malignant mesothelioma, which is the cancer of the pleura or the membrane lining the lungs and the chest cavity. However, the physician would have to consider the location and size of the tumour before even suggesting this surgical procedure as it comes with several risks and possible complications. Pneumonectomy is recommended if the patient is deemed strong enough to undergo the surgery, if the benefits outweigh the risks, and if the tumour has not spread extensively to nearby tissues.

Patients suffering from chronic lung infections or congenital lung disease as well as those suffering from extensive injury to the lung that leads to bronchial obstruction can also be considered for lung removal.

In some rare cases, pneumonectomy is also used to treat tuberculosis.

Following surgery, the patient remains in intensive care, attached to a ventilator to assist in breathing. After several weeks, the patient can be advised to go home and to avoid strenuous activities in the next few months.

Pneumonectomy has good survival rate, more so for those who have their left lung removed compared to those whose right lung is surgically removed. Most patients report shortness of breath following surgery and this symptom may persist for several months, as the remaining lung would need to take over the loss of its counterpart.

How Does the Procedure Work?

The procedure for lung removal starts with the patient being anesthetized and intubated to breathe through a ventilator. The surgeon makes an incision in the chest area and exposes the rib cage. The ribs are then spread apart to access the lungs. The affected lung is collapsed and the surgeon will cut blood supply by tying off the major blood vessels. The bronchus, a major airway leading to the affected lung, is also cut and tied off. The lung is then removed and the surgeon closes the incision using sutures. A drain is left between two membranes surrounding the remaining lung but will be removed later on.

Possible Complications and Risks

During surgery, there is an inherent risk of bleeding if there is an injury to the artery or any nearby blood vessel. Patients could also have an adverse reactions to anaesthesia used.

Following pneumonectomy, a bacterial infection could possibly set in. Medical personnel should also need to look out for possible bronchopleural fistula, which is an abnormal connection between the bronchus and the space between lung membranes.

Another possible complication is the accumulation of fluid or pus in the lung, which could be considered an emergency.

Most patients who undergo pneumonectomy experience respiratory insufficiency, manifested in symptoms such as hypoxia fever, tachycardia, or tachypnea. Additionally, some patients exhibit altered mental status. To address this, they are supplied with oxygen even after they have been discharged.

In patients who have histories of heart conditions, there is a risk of stroke or cardiac arrhythmias. Blood clots could also develop and cause deep vein thrombosis or pulmonary embolism.

The space left by the removed lung could be filled by other organs in the chest and cause a condition called postpneumonectomy syndrome.

Some patients report persistent pain in the chest area that does not go away even after surgery. In some cases, kidney problems or even renal failure could also occur.

References

  • Putnam JB Jr. Lung, chest wall, pleura, and mediastinum. In: Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap 58.

  • Tsiouris A, Horst HM, Paone G, Hodari A, Eichenhorn M, Rubinfeld I. Preoperative risk stratification for thoracic surgery using the American College of Surgeons National Surgical Quality Improvement Program data set: Functional status predicts morbidity and mortality. J Surg Res. 2012: epub ahead of print.

  • Wiener-Kronish JP, Shepherd KE, Bapoje SR, Albert RK. Preoperative evaluation. In: Mason RJ, Broaddus C, Martin T, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Saunders Elsevier;2010:chap 26.

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