Surgical Procedures: Pneumonectomy
What is a pneumonectomy and how is it performed?
A pneumonectomy is the removal of one whole lung. The lungs are two large organs in the chest cavity. The job of the lungs is to filter oxygen and put it into our blood. The lungs also protect us from harmful substances like smoke, pollution, bacteria and viruses. They trap and partially kill these substances in mucus that is made by the lungs. This mucus is then removed from the body by coughing and/or swallowing.
Each lung is made up of lobes or sections. The left lung has two lobes. The right has 3 lobes, and is larger.
A pneumonectomy may be used to treat some cases of:
- Lung cancer.
- Malignant mesothelioma.
- Traumatic injury.
- Disseminated thymomas.
- Bronchial obstruction.
- Congenital lung disease.
- Lung infections such as tuberculosis.
There are two types of pneumonectomy:
- Traditional/Standard Pneumonectomy: Removal of the entire lung.
- Extrapleural Pneumonectomy: Removal of the entire lung, as well as a part of the membrane that covers the heart (pericardium), part of the diaphragm, and the membrane which lines the inside of the chest (pleura).
A pneumonectomy is done during a surgery called a thoracotomy. During a thoracotomy, an incision (cut) will be made between two ribs, from the front of the chest around to the back. This allows the surgeon to remove the lung and anything else that need to be removed.
What are the risks associated with a pneumonectomy?
There are risks and side effects related to having a pneumonectomy. Risks and side effects may be:
- Need for a machine to help you breathe (ventilator/respirator).
- Reaction to anesthesia. (Anesthesia is the medication you are given to help you sleep through the surgery, not remember it and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure.)
- Heart issues including arrhythmias (irregular heartbeat) and heart attack.
- Pulmonary embolism. (Blood clot in the lung.)
- Infection at the incision.
- Broncopleural Fistula. (Abnormal connection between the bronchus and pleural space.)
- Pleural abscess called an empyema and/or fluid in the lungs.
- Organ failure, such as kidney failure.
- Injury to surrounding lung and/or blood vessels.
- Long term shortness of breath and/or the need for long term oxygen.
- Postpneumonectomy syndrome. (A condition in which the other organs in the chest fill the empty cavity where the lung was removed. A prosthesis may be used to fill the space.)
Your surgeon and healthcare team will discuss with you the specific risks of your procedure.
What is recovery like?
Recovery from a pneumonectomy will depend on the extent of the procedure you have had. Often, a 7-10 day hospital stay is required. After surgery, you will be on a ventilator/respirator and have tubes in your chest that will remove extra fluid and/or air.
You will be told how to care for your incisions and will be given any other instructions before leaving the hospital.
Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention, and/or other conditions.
Your provider will talk to you about any restrictions you will have. In general:
- Keep your incisions clean and dry, avoiding the use of creams, lotions, or ointments unless told otherwise.
- Rest. Feeling tired and fatigued is a normal part of recovery.
- Avoid any activity that causes pain.
- Do not lift anything heavy.
- When lying down, be sure to lie on the side where you had surgery so that your remaining lung is facing upward.
- Avoid smoking and second hand smoke. If you would like help quitting, speak to your provider.
- Often, you can return to work around 8 weeks after surgery, depending on the type of job you have and if you have fully recovered.
- Do not drive while taking narcotic pain medication.
- Take and record your pulse (heart rate) as directed.
- Be sure to use your incentive spirometer and cough as directed by your healthcare team. Often, you will be asked to use it 5-10 times per day for 2 weeks.
- Use supplemental oxygen as directed by your healthcare team.
What will I need at home?
- Thermometer to check for fever, which can be a sign of infection.
- Tablet or journal to record your vital signs and any changes.
- Wound care and oxygen supplies, which are provided to you by the hospital or doctor's office.
When do I need to contact my healthcare team?
- Fever. Your care team will tell you at what temperature they should be notified.
- Drainage, redness, swelling or pain at your incision.
- Nausea or vomiting.
- New or worsening pain.
- Shortness of breath, chest pain or bloody, yellow, green or brown sputum.
- Swelling in the leg or legs.
- Irregular, racing or abnormal heartbeat.
Seek IMMEDIATE medical attention if:
- You are having chest pain or difficulty breathing.
- Your surgical bandage is soaking with blood.
- Your incision comes apart (separates).
- You are coughing up blood (more than a teaspoon) or you have large amounts of brown/bloody sputum.
- If you are in distress, call 911 and lie on the side that you had the surgery on, leaving your remaining lung facing upward.
How can I care for myself?
You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.
Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.
There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.
Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.
- Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.
Harvard Medical School. Pneumonectomy. Retrieved from http://www.patienteducationcenter.org/articles/pneumonectomy/ on July 26, 2018
Mueller, D; et al. Pneumonectomy: Indications. (December 15, 2015) Retrieved from http://emedicine.medscape.com/article/1969902-overview#a2 on July 26, 2018
Mount Nittany Health. Discharge Instructions for Pnuemonectomy. Retrieved from https://www.mountnittany.org/articles/healthsheets/2343 on July 26, 2018
Canadian Cancer Society. Anatomy and physiology of the lung. Retrieved from http://www.cancer.ca/en/cancer-information/cancer-type/lung/anatomy-and-physiology/?region=on on July 26, 2018
Lung Surgery. Retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/002956.htm on July 26, 2018
American Cancer Society. Surgery for Non-Small Cell Lung Cancer. Retrieved from https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/surgery.html on July 26, 2018