Pneumonectomy for Mesothelioma
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A pneumonectomy is a surgical procedure sometimes used to treat pleural mesothelioma and that removes an entire lung from the chest cavity. Although this procedure can cause serious complications, a pneumonectomy may provide some patients with the best chance of survival.
What Is a Pneumonectomy Surgery?
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 resection, which removes one lobe of a lung or a portion.
How Is a Pneumonectomy Performed?
To perform a pneumonectomy, a surgeon makes an incision in the patient’s side, separates the ribs and tissue, and removes one entire lung.[1]
It is possible, but not common, to perform this surgery with a thoracoscope. A thoracoscope is a small camera that can be used to perform the procedure with a smaller incision.
How Long Does a Pneumonectomy Procedure Take?
Pneumonectomy is an extensive procedure, but with minimal complications can be completed in a few hours. It often takes longer for mesothelioma patients because the surgeon might remove cancerous tissue from other areas of the chest cavity at the same time.
What Fills the Space After Pneumonectomy?
Pneumonectomy patients do not receive a transplanted or prosthetic lung. The postpneumonectomy space fills with air after the procedure.
Over time, the other lung and the diaphragm expand more and fill some of the space. Eventually, the body absorbs the air and the space fills with fluid.
Pneumonectomy as Part of Multimodal Mesothelioma Treatment
Some patients may also receive additional therapy after the procedure, including chemotherapy and radiation, to reduce the risk of cancer recurrence.
This combination of treatments is known as multimodal treatment and is the most common strategy for managing mesothelioma.
What a Pneumonectomy Treats
Pneumonectomy is most commonly used to treat patients with lung cancer. Any 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.[1]
Pleural mesothelioma may also be treated with a pneumonectomy. However, the surgeon is more likely to remove more than just the lung because this cancer is so aggressive.[2]
Benefits of a Pneumonectomy for Mesothelioma Patients
The most obvious benefit of pneumonectomy is curing the 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 pain.
Once the diseased lung is removed, the patient may get relief from these symptoms. This can allow for greater activity and mobility.
Potential Risks of Pneumonectomy
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 most significant risk.
Some studies have found the mortality rate after pneumonectomy is as high as 9.4%. This is compared to a mortality rate of 5% for a less radical lobectomy.
Other risks include:[1]
- Respiratory failure
- Ongoing breathing problems
- Infection, Excessive bleeding
- Blood clots in the remaining lung
- Abnormal heart rhythms
- Reduced blood flow to the heart
- Complications related to general anesthesia
Who Is a Good Candidate for a Pneumonectomy?
Because the procedure is risky, not all pleural mesothelioma patients are good candidates. For example, if 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 cancer has already spread, removing the lung will not help.
A 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 receive careful screening 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.
Who Is Not a Good Candidate for Pneumonectomy?
Patients in overall poor health or with specific health problems might not be good candidates for this procedure. Lung function is a critical factor. If the function of the remaining lung isn’t good enough, the mortality risk is too high.
In terms of mesothelioma, patients with metastasis are generally not considered candidates for pneumonectomy. The cancer in this case is too widespread and the extensive surgery offers more risks than benefits.
How to Prepare for Pneumonectomy
Your surgeon and medical team will help you prepare for this procedure with specific instructions. It is important to follow these carefully for the best results and optimal recovery. While each patient is different, general preparation includes:
- Taking chest X-rays and CT scans
- Undergoing an electrocardiogram to monitor heart rhythm or find any abnormalities
- Testing pulmonary function to determine how well the lungs work
- Blood testing to monitor overall health
- Stopping the use of certain medications
- Using breathing exercises to strengthen the lung
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 a full recovery. Patients may always live with impaired lung function.
After the procedure, the patient must remain in the hospital for monitoring. A respirator can help the patient breathe, and drainage tubes may remove fluid from the chest cavity. A therapist may also work with patients to improve their breathing and oxygen intake.[1]
A pneumonectomy is not a surgery to be taken lightly; however, it may provide an opportunity for a cure or remission for patients with lung cancer. 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.
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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.