Pneumonectomy Surgery for Lung Cancer

Lung cancer originates in the tissues of the lungs, usually in the cells lining the air passages (bronchi). The lungs are divided into lobes and segments. The right lung has three lobes (upper, middle and lower) and the left lung has two lobes (upper and lower). Each lobe is further divided into segments. These divisions help physicians identify and treat specific parts of the lung.

The main types of lung cancer are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC accounts for approximately 80% of lung cancer cases and tends to grow slowly, while SCLC is less common but more aggressive.

Smoking is the leading cause of lung cancer. Other risk factors include exposure to secondhand smoke, radon gas, asbestos and other environmental toxins. Symptoms often include a persistent cough, chest pain, shortness of breath and unexplained weight loss. An early diagnosis can help ensure effective treatment, which may involve pneumonectomy surgery, radiation therapy and/or chemotherapy.

Why is pneumonectomy performed?

Pneumonectomy is performed to remove an entire lung. This procedure may be considered to treat a large tumor that is centrally located in a lung or involves multiple lobes, making it difficult for a surgeon to achieve clean margins with a less extensive procedure, such as segmentectomy (removal of one segment) or lobectomy (removal of one lobe). The primary goal of pneumonectomy is to completely remove the cancerous tissues, thereby reducing the risk of recurrence and improving the patient's outcome and quality of life.

Who is a good candidate for pneumonectomy?

In addition to having a large lung tumor that is centrally located or involves multiple lobes, a good candidate for pneumonectomy is in generally good health. Typically, a physician will perform a thorough assessment of the patient’s cardiovascular and respiratory fitness to confirm that the patient has sufficient lung function to tolerate the removal of one lung. The physician will also check for concurrent medical conditions that could complicate the surgery or recovery.

How to prepare for pneumonectomy

Preparing for pneumonectomy usually includes undergoing preoperative testing, adjusting medication use and making arrangements for recovery. To help ensure that the patient is healthy enough for lung cancer surgery, the physician will likely order blood work, a urinalysis, a chest X-ray and an electrocardiogram (EKG). The patient will then meet with the surgical team to discuss the test results, specifics of the procedure, postoperative expectations and recovery process.

The patient may be instructed to stop taking certain medications, such as aspirin, clopidogrel (Plavix) and warfarin (Coumadin), approximately one week before the procedure to reduce the risk of excessive bleeding. If the patient is diabetic, they may receive special instructions about their oral medications and/or insulin.

Before surgery, the patient should arrange for time off from work for their procedure and recovery, transportation to and from their medical appointments and help at home. For instance, the patient may initially need assistance to get dressed, move in and out of bed, prepare meals and complete household chores.

What happens during pneumonectomy?

After the patient receives general anesthesia, the surgeon will typically begin the procedure with thoracotomy, which involves making an incision in the chest wall to access and remove the cancerous lung and other tissues.

The two main types of pneumonectomy are:

• Traditional pneumonectomy – Removal of one lung in its entirety
• Extrapleural pneumonectomy – Removal of one entire lung along with a portion of the muscle layer between the lungs and abdomen (diaphragm), a portion of the membrane covering the heart (pericardium) and a portion of the membrane lining the chest cavity (parietal pleura)

What are the risks and possible complications of pneumonectomy?

Pneumonectomy, like any major surgery, has some risks, such as infection, excessive bleeding and reaction to anesthesia. Potential complications include pneumonia, breathing difficulties and heart-related issues due to increased strain on the remaining lung and cardiovascular system. These risks and complications will be carefully monitored and managed by the surgical team if necessary. Although pneumonectomy will likely result in reduced lung function and stamina, most patients recover well.

What to expect during recovery from pneumonectomy

After pneumonectomy, the patient can expect to remain in the hospital for about a week, where they will receive pain management, respiratory support and monitoring for any complications. The patient may have drainage tubes in place for a few days to remove excess fluids from the surgical site. To improve lung function and mobility, breathing exercises and physical therapy will gradually be introduced.

Once home, the patient should follow their surgeon’s postoperative instructions and attend regular follow-up appointments. Full recovery can take several weeks to months, during which the patient can expect to experience some fatigue and reduced stamina as their remaining lung adjusts to its increased workload.

How effective is pneumonectomy?

Pneumonectomy can be effective, particularly for a patient with a localized tumor that has not spread beyond the lung. That said, the results can vary depending on the stage and location of the tumor, the patient’s overall health and the effectiveness of any additional treatments, such as radiation therapy and chemotherapy. While pneumonectomy is a major surgery with a significant recovery period, many patients achieve a good outcome and quality of life.

Is it possible to live normally with one lung?

After one lung is removed, the remaining lung can usually take in enough oxygen and remove enough carbon dioxide from the body to provide sufficient respiratory function. The opposite lung may also expand, shifting the heart into the empty chest cavity and decreasing the space within it.

That said, pneumonectomy will decrease the patient’s breathing capacity by approximately one-half. Therefore, while the patient may be able to perform most everyday tasks, they might be unable to exercise as strenuously as an individual with two healthy lungs.

Benefit from world-class care at Moffitt Cancer Center

Pneumonectomy is a technically complex procedure that requires highly refined surgical expertise. Because Moffitt is a high-volume cancer center, our thoracic surgical oncologists have acquired extensive experience in performing lung cancer surgery using the latest techniques and technologies, such as robotic-assisted surgery and sleeve lobectomy. Also known as bronchial sleeve resection, sleeve lobectomy is a less invasive alternative to pneumonectomy that preserves some lung tissue, which may be an option for some patients. Moffitt also has a robust portfolio of clinical trials, providing our patients with unique opportunities to benefit from promising new treatments that are not yet available in other settings.

If you would like to learn more about pneumonectomy, you can request an appointment with a specialist in Moffitt’s Thoracic Oncology Program by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.