Pneumonectomy

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

Although there are serious risks of undergoing this procedure, a pneumonectomy may provide the best chance of survival for some patients. For mesothelioma patients, it is more common to perform an extrapleural pneumonectomy, but 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. This is a small camera that can be used to remove the lung in a less invasive way and with a smaller incision. Some patients may also receive additional therapy after the procedure, including chemotherapy and radiation for cancer patients to reduce the risk of a recurrence.

What a Pneumonectomy May Treat

The most common condition treated by this procedure is lung cancer. Any type of lung cancer may be treated in this way, including those cases caused by exposure to asbestos. By removing the entire lung, a patient with lung cancer may have a chance at remission because all of the diseased tissue is removed from the body. A surgeon may recommend a pneumonectomy over a resection or lobectomy if the 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, a bronchial blockage, or metastatic cancer that has spread to the lung. Pleural mesothelioma may also be treated with a pneumonectomy, but because the cancer is so aggressive and spreads so readily, it is more likely that a patient will have more than just the lung removed in an attempt to achieve remission.

Benefits of a Pneumonectomy

The most obvious benefit of a pneumonectomy is curing the disease to be treated. In the case of lung cancer, this means going into remission. This is the hope and the number one goal of treating someone with cancer by performing a pneumonectomy. Additionally, there are other possible benefits. Even if the procedure is not curative, it may give a patient an extended life expectancy with the cancer recurring only years later.

Other potential benefits of undergoing this procedure include relief from symptoms. Lung cancer and mesothelioma cause debilitating symptoms like fluid in the chest cavity, difficulty breathing, shortness of breath, and chest pains. With the diseased lung removed, the patient may get relief from these symptoms after recovering. This can provide the patient with a better quality and allow for greater activity and mobility.

Potential Risks

The risks of removing one lung surgically are high. This is not a simple procedure and many things can go wrong, even things that are out of the control of the surgical team. The biggest risk is dying because of the surgery. Some studies have found that the mortality rate after a pneumonectomy is as high as 9.4 percent. This is as compared to a mortality rate of five percent for a less radical lobectomy.

Other risks include respiratory failure, ongoing breathing problems, pneumonia and other infections, excessive bleeding, blood clots in the lung, abnormal heart rhythms, and reduced blood flow to the heart, as well as complications that are possible with any surgery that requires general anesthesia. Furthermore, there is always the risk that the cancer will return after facing the risks of such a radical surgical procedure.

Good Candidates for a Pneumonectomy

Because the procedure is so risky and invasive, not all patients living with mesothelioma or lung cancer are good candidates. If the cancer has spread beyond the lung, for instance, the potential benefits are likely not worth the risks of complications 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 also be in good health aside from the underlying condition prompting the surgery. Having other illnesses can significantly increase the risk of complications, including death. One study, for instance, found that a high risk of mortality after a pneumonectomy was strongly associated with coronary artery disease.

Patients who may undergo a pneumonectomy must be carefully screened for good pulmonary function, a healthy heart, and other health conditions. Age is also a factor and some patients may be considered too old to be able to withstand the surgery as well as the chemotherapy or radiation therapy that may be necessary after the procedure.

Recovery after the Procedure

Recovery from such an invasive and radical surgery is long and progress may be slow. It may take as much as two months or more for a patient to recovery fully, and even then the patient may not experience full recovery. Patients may always live with some impaired lung function or the repercussions of other complications.

Immediately after the procedure the patient needs to remain in the hospital for monitoring and treatment of any complications. A respirator may be needed initially as well as drainage tubes to 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 decided on lightly. For patient with lung cancer, though, it may provide an opportunity for a cure or remission. If you are facing this decision, take your time and ask all the questions you need to feel comfortable going forward. The risks are high, but so are the benefits.