Surgical Procedures: Pneumonectomy

Lori Smith, CRNP
Last Modified: August 1, 2016

What is a pneumonectomy and how is it performed?

A pneumonectomy is a surgical procedure that is done to remove the lung in its entirety. The lungs are the two large organs within the chest cavity, responsible for getting oxygen into our blood and removing carbon dioxide. The lungs also provide protection from harmful environmental substances like smoke, pollution, bacteria and viruses, trapping and partially killing these substances in the mucus produced by the lungs. This mucus is then expelled 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.

Whenever possible, surgeons try to save as much of the lung as possible, removing only the affected portion (called lobectomy). However, a pneumonectomy may be recommended in the treatment of some cancers, such as lung cancer or malignant mesothelioma. It may also be recommended in non-cancerous, or benign conditions, such as a traumatic injury, disseminated thyomas, bronchial obstruction with destroyed lung, congenital lung disease, and lung infections such as tuberculosis.

There are two different types of pneumonectomy:

  • Traditional/Standard Pneumonectomy: This approach to removing the lung removes the entire diseased lung.
  • Extrapleural Pneumonectomy: During this procedure, the entire diseased lung is removed, as well as a portion of the membrane which covers the heart, called the pericardium, a portion of the diaphragm, and the membrane which lines the inside of the chest, called the pleura.

A pneumonectomy is generally performed using a thoracotomy. During a thoracotomy, a surgical incision will be made between two ribs, extending from the front of the chest around to the back and the deflated lung will be removed, as well as any other required organs depending on the type of pneumonectomy being performed.

What are the risks associated with a pneumonectomy?

As with any surgical procedure, there are risks and side effects associated with undergoing a pneumonectomy. Some risks and side effects associated with pneumonectomy may include:

  • Need for prolonged mechanical ventilation
  • Reaction to anesthesia
  • Bleeding
  • Cardiac complications including arrhythmias and heart attack
  • Pulmonary embolism (blood clot in the lung)
  • Pneumonia
  • Incisional infection
  • 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 supplementation
  • Postpneumonectomy syndrome, which is a condition in which the other organs within the chest fill the empty cavity where the lung was removed, at times requiring the placement of a prosthesis to fill the space.

It is important to speak with your thoracic surgeon about risk factors which may affect you specifically.

What is recovery like?

Recovery from a pneumonectomy will depend on the extent of the procedure performed. Typically, a 7-10 day hospital stay is required. Following surgery, you will be on a respirator and have chest tubes.

You will be instructed on how to care for your surgical incisions and will be given any other instructions prior to leaving the hospital.

Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, constipation prevention, and/or other conditions.

Although your healthcare provider will discuss your particular activity restrictions, generally it is advised that you:

  • Keep your surgical incision clean and dry, avoiding the use of creams, lotions, or ointments unless instructed otherwise.
  • Rest as required; fatigue is a normal part of recovery.
  • Avoid any activity that causes pain.
  • Avoid heavy lifting; nothing over 10 pounds for 4-6 weeks.
  • Increase your activity as tolerated; avoid strenuous activity.
  • Avoid long periods of sitting with legs down or crossed.
  • 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.
  • You can typically return to work around 8 weeks after surgery, however your healthcare team will provide instruction on when it is safe for you to return to your job.
  • Avoid driving while on pain medications and if you are still experiencing pain.
  • Be sure to take and record your temperature daily for the first week following surgery and when needed.
  • Take and record your pulse (heart rate) as directed.
  • Be sure to use your incentive spirometer and cough as directed by your healthcare team; typically, you will be asked to use it 5-10 times per day for 2 weeks.
  • Use supplemental oxygen as directed by your healthcare team; avoid smoking or being around someone who is smoking with oxygen in the room.

What will I need at home?

  • Thermometer to check for infection
  • Tablet or journal to log your vital signs
  • Wound care and oxygen supplies, which are typically provided to you by the hospital or doctors’ office

When do I need to contact my healthcare team?

  • Fever of >101 degrees F
  • Incisional drainage, redness, swelling or pain
  • Nausea or vomiting
  • 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 separates
  • You are coughing up blood (more than a teaspoon) or 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?

Depending on the extent of your surgery, you may need a family member or friend to help you with your daily tasks until you are feeling better and your medical team gives you the go ahead to resume normal activity.

Be sure to take your medications as directed to prevent pain, infection and/or constipation and call your medical team with any concerning symptoms.

If you experience constipation, diet modifications, increased fluid intake, and over-the-counter medication to relieve constipation may be helpful. Speak with your healthcare team to determine what the best constipation relieving method is for you.

Deep breathing and relaxation are important to help with pain, keep lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to perform deep breathing and relaxation exercises several times a day in the first week, or whenever you notice you are particularly tense.

  • A simple exercise to do on your own: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
  • Find more relaxation exercises on OncoLink.

This hand-out provides general information only. Please be sure to discuss the specifics of your surgical plan and recovery with your surgeon.

References

Harvard Medical School. Pneumonectomy. Retrieved from http://www.patienteducationcenter.org/articles/pneumonectomy/ on June 19, 2016

Cancer Treatment Centers of America. Pneumonectomy. Retrieved from http://www.cancercenter.com/treatments/pneumonectomy/ on June 19, 2016

Mueller, D; et al. Pneumonectomy: Indications. (December 15, 2015) Retrieved from http://emedicine.medscape.com/article/1969902-overview#a2 on June 19, 2016

Encyclopedia of Surgery. Pneumonectomy. Retrieved from http://www.surgeryencyclopedia.com/Pa-St/Pneumonectomy.html in June 19, 2016

Mount Nittany Health. Discharge Instructions for Pnuemonectomy. Retrieved from https://www.mountnittany.org/articles/healthsheets/2343 on June 19, 2016

Pneumonectomy. Retrieved from https://www.drugs.com/cg/pneumonectomy-discharge-care.html on June 19, 2016

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 June 19, 2016

Lung Surgery. Retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/002956.htm on June 19, 2016

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