Pneumonectomy

A pneumonectomy removes an entire lung from the chest cavity. This invasive and radical surgery is more complicated than removing only the diseased tissue from a lung but less radical than an extrapleural pneumonectomy, which removes a lung, the pleura, lymph nodes, and diaphragm. The procedure may be used to treat a number of serious conditions, including mesothelioma.

Although this procedure has serious risks, a pneumonectomy may provide the best chance of survival for some patients. For mesothelioma patients, an extrapleural pneumonectomy is typically more common. However, removal of only the lung can be useful for those with lung cancer caused by asbestos exposure. Candidates for surgery must be carefully vetted and disqualified if other health problems make the procedure too risky.

What Is a Pneumonectomy?

A pneumonectomy is a surgical procedure that removes an entire lung. This is in contrast to procedures that only remove part of a lung, like a lobectomy or a resection, procedures that remove one lobe of a lung or a portion of a lobe. To perform a pneumonectomy a surgeon makes an incision in the patient’s side, separates the ribs and tissue, and removes one entire lung.

It is possible, but not common, to perform this surgery with a thorascope. A thorascope is a small camera that can be used to perform the procedure with a smaller incision. Some patients may also receive additional therapy after the procedure, including chemotherapy and radiation to reduce the risk of cancer recurrence.

What a Pneumonectomy May Treat

Pneumonectomy is most commonly used to treat patients with lung cancer. Any type of lung cancer may be treated in this way, including those caused by exposure to asbestos. By removing the entire lung, a lung cancer patient has the best chance of remission because all the diseased tissue is removed from the body. A surgeon may recommend a pneumonectomy over a resection or lobectomy if cancerous tissue is extensive throughout the lung, in the center of the lung, or is difficult to reach and remove.

Other conditions that may warrant a pneumonectomy include tuberculosis, congenital lung diseases, traumatic lung injury, bronchial blockage, or metastatic cancer that has spread to the lung. Pleural mesothelioma may also be treated with a pneumonectomy. However, because this cancer is so aggressive, removal of more than just the lung is more likely.

Benefits of a Pneumonectomy

The most obvious benefit of a pneumonectomy is curing disease. Additionally, there are other possible benefits for cancer patients. Even if the procedure is not curative, it may extend life expectancy with the cancer recurring years later.

Other potential benefits include relief from symptoms. Lung cancer and mesothelioma cause debilitating symptoms, including fluid in the chest cavity, difficulty breathing, shortness of breath, and chest pains. Once the diseased lung is removed, the patient may get relief from these symptoms. This can allow for greater activity and mobility.

Potential Risks

The risks of surgically removing one lung are high. This is not a simple procedure and it has many potential complications, including things out of the control of the surgical team. Death is the biggest risk. Some studies have found the mortality rate after a pneumonectomy is as high as 9.4 percent. This is compared to a mortality rate of five percent for a less radical lobectomy.

Other risks include respiratory failure, ongoing breathing problems, infection, excessive bleeding, blood clots in the lung, abnormal heart rhythms, reduced blood flow to the heart, and complications related to requires general anesthesia.

Good Candidates for a Pneumonectomy

Because the procedure is risky, not all patients are good candidates. For example, if the cancer has spread beyond the lung, the potential benefits are not worth the risks of the surgery. The surgery is only performed when there is a chance that it could be curative or lead to remission. If the cancer has already spread, removing the lung will not help.

A good candidate for the procedure must be in good health aside from the underlying condition prompting surgery. Poor health significantly increases the risk of complications, including death. One study, found a high risk of mortality after a pneumonectomy was strongly associated with coronary artery disease.

Patients who may undergo a pneumonectomy are carefully screened for pulmonary function and heart health. These studies help estimate if they have enough lung capacity to tolerate having just one lung. Age is also a factor, with some patients considered too old to withstand the surgery and chemotherapy or radiation therapy necessary after the procedure.

Recovery after the Procedure

Recovery from such a radical surgery is long, and progress may be slow. Two months or more may be necessary for recovery, and even then the patient may not experience full recovery. Patients may always live with impaired lung function. After the procedure, the patient must remain in the hospital for monitoring. A respirator may be used to help the patient breathe and drainage tubes may remove fluid from the chest cavity. A therapist may also work with patients to improve breathing and oxygen intake.

A pneumonectomy is not a surgery to be taken lightly. However, for patients with lung cancer, it may provide an opportunity for a cure or remission. If you are facing this decision, take all the time you need to feel comfortable going forward. The risks are high, but so are the potential benefits.

Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP

Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.

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