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Pneumonectomy

This page was reviewed under our medical and editorial policy by

Peter Baik, DO, Thoracic Surgeon.

This page was updated on September 26, 2022.

A pneumonectomy—a surgical procedure that removes all of the lung in one side of the chest—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 done to treat malignant mesothelioma.

A pneumonectomy isn’t the only type of lung surgery. For most lung cancers, pneumonectomy isn't the right option, and in some cases, patients may not have enough lung function to accommodate an entire lung being 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, an anatomic resection that removes the lobe's vessels and the airway. It may be done to treat non-small cell lung cancer (NSCLC).
  • Segmentectomy: The lung is divided into segments during this procedure, and a portion of the lung is removed.
  • Sleeve resection: This surgery removes the tumor in a lobe as well as part of the major bronchus (airway). The ends of the bronchus are reattached, which allows for removal of less lung tissue.
  • Wedge resection: During this procedure, the surgeon removes only a portion of the lung that contains the nodule/tumor. This surgery is usually reserved for diagnosis or for patients who may not tolerate a major anatomic resection. During the procedure, the surgeon does not remove the involved segmental vessels and airway.

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 (robotic-assisted thoracic surgery, or RATS).

For full pneumonectomies, however, doctors usually 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 VATS or RATS (several smaller incisions).

Why is a pneumonectomy performed?

A pneumonectomy may be performed as part of treatment for a mesothelioma or other types of lung cancers besides small-cell or non-small-cell lung cancers. Because of the increased risks associated with pneumonectomy, a thorough clinical workup should be performed prior to the procedure.

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?
  • Is pneumonectomy my only option?
  • 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 there is no evidence of bleeding, which usually takes one or two days following surgery. Even after the chest tube is removed, because of the significant changes in the body, most patients will remain in the hospital for close monitoring.

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
  • Injury to the lungs, blood vessels, diaphragm, esophagus or trachea
  • Air leak
  • Breakdown of the main bronchus, leading to a possible fistula between the airway and the chest cavity
  • Irregular heart rhythm
  • Failure of the lung to deliver enough oxygen to the body, requiring a machine to assist with breathing
  • Heart attack

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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