A pneumonectomy is the medical term for the removal of a lung. It is a major surgical procedure that aims to entirely eradicate unhealthy or tumorous lung tissue, and in the case of lung cancer or pleural mesothelioma, prevent the spread of malignant cells to other sites in the body.
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The decision to perform a pneumonectomy, rather than a lesser form of lung resection, is based on the degree of invasion of mediastinal lymph nodes (nodes within the chest cavity) as well as the type, size and location of tumors in the lung. A 10-year study of 193 pneumonectomies performed in Switzerland between 1990 and 2000 found that squamous cell carcinoma was the most common histologic type of cancer for which the procedure was implemented (69 percent), followed by adenocarcinoma (22 percent). The surgery was performed mainly for early stages of the disease (stage I, 28%; stage II, 26%; stage IIIA, 33%; stage IIIB, 12%; stage IV, 2%).
In spite of improvements in operative techniques and post-operative care, this surgery still presents higher mortality and morbidity rates than lesser resection surgeries, such as a lobectomy. In fact, in one study comprising 433 patients, the mortality after pneumonectomy was almost twice that of a lobectomy (9.4 vs. 5.0 percent). Therefore, surgeons must balance the operative risks of the procedure against the hoped-for benefits in terms of increased survival time and quality of life.
Doctors will generally not recommend this surgery in cases where a patient's cancer has already metastasized to other parts of the body, or the remaining lung is not in good working condition. In addition, candidates must be in relatively good health, with strong heart function and a good prognosis for recovery, as the aggressive operation leads to an early permanent loss of about 33 percent of pulmonary function and a 20 percent loss in exercise capacity (the amount of physical exertion that a patient can sustain).
This surgery is performed under general anesthesia. The surgeon begins the operation by performing a thoracotomy, which is a long incision on the same side of the chest as the diseased lung. Sometimes all or part of a rib will be removed to get a better view and help facilitate surgery. The affected lung will be then be collapsed, and any attached blood vessels will be clamped, cut, and tied off, along with the bronchus, the main tube flowing air into the lung. The diseased organ can then be removed through the incision. The cut tubes and vessels are thoroughly inspected to ensure that nothing is leaking, and a temporary drainage tube is inserted to draw air, fluid and blood out of the surgical cavity before the chest incision is closed.
Patients will need to breathe with the assistance of a respirator for the first few days after the operation, and the drainage tubes will remain in place to remove fluid buildup. They may be fed and medicated intravenously before being transferred from intensive care to a regular hospital room.
Full recovery may take as long as two or three months.
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The prognosis following surgery depends on many factors, including which lung is removed; the type and stage of a patient's cancer; gender; and the patient's age and health. Approximately 60 percent of patients struggle with shortness of breath for up to six months following surgery, as the remaining lung gradually takes on the work of two lungs. The risks for any surgical procedure include adverse reactions to medication, bleeding and infection.
Despite the risks, successful pneumonectomy (or extrapleural pneumonectomy) surgery can greatly improve the quality of life for lung cancer or mesothelioma patients by reducing the debilitating symptoms of their disease, while adding several months to their lives. In the U.S., the immediate survival rate for left lung removal is between 96 and 98 percent, and for right lung removal, between 88 and 90 percent (because of greater risk of complications involving the stump of the cut bronchus).
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