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Pneumonectomy

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

A pneumonectomy—a surgical procedure that removes all of one lung—is a treatment option for some types of lung cancers, chest injuries or other conditions. It’s a major operation that usually requires general anesthesia for the surgery and several days in the hospital for recovery.

Doctors may perform a standard pneumonectomy or an extrapleural pneumonectomy, which removes a lung and parts of surrounding structures, including the pericardium (tissue covering the heart), diaphragm and parietal pleura (tissue lining the chest cavity). As a cancer treatment, it’s typically only done to treat malignant mesothelioma.

A pneumonectomy isn’t the only type of lung surgery. Less extreme surgeries may be an option to treat cancer that doesn’t require removal of an entire lung and/or for people who won’t have enough lung function if an entire lung is removed. You and your cancer care team may carefully weigh the risks and benefits of different types of lung surgeries based on the cancer type and location. Doctors will also consider your current lung function and ability to physically withstand an invasive surgery.

Other types of lung surgery include:

  • Lobectomy: This surgery removes one or more of the five lobes in the lungs. It may be done to treat non-small cell lung cancer (NSCLC) if a full pneumonectomy isn’t needed.
  • Segmentectomy: Also called a wedge resection, this surgery removes only part of one lobe.
  • Sleeve resection: This surgery removes the tumor in a lobe as well as part of the main bronchus (airway). The ends of the bronchus and remaining lobes are reattached to the bronchus.

These other types of surgeries may be performed using several small incisions, with the aid of a camera on a scope (video-assisted thoracic surgery, or VATS) or of a robotic system.

For full pneumonectomies, however, doctors typically must perform a thoracotomy, in which they make a large incision between the ribs to reach the lungs Generally, it takes longer to heal after a thoracotomy (one big incision) than a thoracoscopy (several smaller incisions).

Why is a pneumonectomy performed?

A pneumonectomy may be performed as part of treatment for a number of early-stage lung cancers, including stage 1 and stage 2 non-small cell lung cancer, the most common type of lung cancer. About 84 percent of lung cancers are NSCLC cases, according to the American Cancer Society (ACS).

A pneumonectomy is an especially appropriate treatment option if a tumor is found close to the center of the chest. It may also be a treatment option for a rare type of lung cancer called a lung carcinoid tumor.

Small cell lung cancer is much less common than non-small cell lung cancer, and it’s not often treated with surgery due to its tendency to spread before it gets diagnosed. In these cases, a pneumonectomy, or another type of lung surgery, is only done if the cancer hasn’t spread beyond the initial tumor.

How to prepare for a pneumonectomy

Long before the surgery itself, your cancer care team gathers information that helps them recommend the right type of procedure for you.

Before surgery, you’re likely to undergo tests to check whether:

  • The cancer has spread to any lymph nodes 
  • The lungs work well enough to ensure they’ll function effectively after surgery
  • There are any issues with your heart and other organs

You may undergo blood tests to check your blood count, blood sugar and risk for bleeding problems, as well as a lung X-ray.

Your care team may also recommend that you complete induction treatment, or an initial treatment, before surgery. In the case of pneumonectomy, this is often chemotherapy—called neoadjuvant chemotherapy, since it’s given before the main treatment.

Begin preparing for a pneumonectomy by asking your care team any questions you may have. Questions may include:

  • Will I need any treatment, such as chemotherapy, before surgery?
  • What type of pneumonectomy am I having?
  • Do I need to stop eating and drinking before surgery? When?
  • Should I take my regular medications before surgery?
  • Whom will I be meeting with before the surgery?
  • Can I bring someone with me?
  • How long will the surgery take?
  • How long will I stay in the hospital after surgery?
  • What will my recovery be like?
  • Will I need other treatment after the surgery?

Your care team may have specific instructions for you to follow in the days before and after surgery. Make sure you know how long you should plan to be in the hospital during recovery and how to best prepare your home.

What to expect during a pneumonectomy

A pneumonectomy is performed by a surgeon in a hospital. You’ll be put under general anesthesia, which means you’ll be unconscious—or in a very deep sleep—during the procedure. You’ll meet with several members of your care team before the procedure. Be sure to ask any questions you have along the way.

After a pneumonectomy, you’ll likely need to stay in the hospital for several days to recover—typically about five to seven days. Your care team sets up tubes—or drains—to shuttle excess fluid and air out of your chest. These drains may be removed once the majority of fluid and air has drained out. They also may give you special compression socks that improve circulation and/or injections to help prevent blood clots.

Benefits and risks of a pneumonectomy

For lung cancer that hasn’t spread to the lymph nodes or any other part of the body, the benefit of a pneumonectomy is the high likelihood that it may remove all cancerous cells.

However, a pneumonectomy is a major surgery. Risks of a pneumonectomy include:

  • Infection
  • Fluid buildup in the chest cavity
  • Injury to the lungs, blood vessels, diaphragm, esophagus or trachea
  • Air leak
  • Failure of the lung to expand and deliver enough oxygen to the body

The use of general anesthesia always comes with some risks, such as breathing problems, changes to your heartbeat, an allergic reaction or confusion upon awaking.

You may also experience side effects as you recover from surgery. Be sure to ask your care team which side effects to expect, and which ones may be a sign of a problem.

Alert your care team if you have any of these signs after surgery:

  • Chills
  • Fever
  • Bleeding from the surgery site
  • Worsening pain at the surgery site
  • Breathing difficulties or shortness of breath
  • Urination problems or changes

After your surgery

Be sure to ask your care team when it’s safe to resume certain activities, such as lifting heavy objects and returning to work.

After surgery, your lung function may or may not be similar to what it was before. Because an entire lung is removed in a pneumonectomy, you may notice a difference in how you breathe. Ask your care team what to expect afterward depending on your type of surgery.

Your care team may follow up to let you know how the surgery went⁠—including if they were able to remove all signs of cancer. Regardless of the results, expect to schedule appointments and tests to make sure the cancer isn’t recurring or spreading. You also may need additional treatment to decrease the chance that cancer may return. This is typically chemotherapy—called adjuvant chemotherapy, since it’s given after the main treatment.

3 tips on moving forward after a pneumonectomy

  • Be patient: Because a pneumonectomy is a surgery that removes an entire lung, recovering may take a while. Ask your care team what the months after your surgery may be like. Be patient with the healing process as your body recovers.
  • Communicate with your care team: Your care team is there to answer your questions. Don’t hesitate to share questions or concerns that are on your mind.
  • Seek support: Lung cancer is among the most commonly diagnosed cancers for both men and women, according to the ACS. So if you’re having, or have had, a pneumonectomy to treat lung cancer, you’re not alone. Seek out support through family or friends, or a cancer support group of people who are also undergoing cancer treatment.

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