What is a pneumonectomy?
A pneumonectomy is a surgical procedure that removes an entire lung. It is performed for the treatment of lung cancer. To have this surgery, your other lung must be healthy enough to continue to provide the oxygen your body needs.
There are two types of pneumonectomy procedures:
- Standard pneumonectomy: Also called simple pneumonectomy, this is the most commonly performed type of pneumonectomy. Your surgeon removes only the lung.
- Extrapleural pneumonectomy: Extrapleural pneumonectomy is a more extensive surgery. It removes the lung and parts of the diaphragm, lining around the heart and the lungs.
How is a pneumonectomy performed?
Thoracotomy
Video-assisted thoracic surgery (VATS)
Robot-assisted surgery
Why is a pneumonectomy performed?
Pneumonectomy is a major surgery, so it’s only recommended when other less extensive surgeries are no longer an option. For example, you might need this surgery if you have lung cancer that has grown too much or is located in a hard-to-reach area in the middle of your chest.
Some of the reasons you might need a pneumonectomy include:
- Cancer in the chest, including lung cancer, mesothelioma or cancer that has spread from another area of the body
- Chronic obstructive pulmonary disease, known as COPD
- Fungal and bacterial infections in the lung, including tuberculosis
- Lung injuries
- Bronchiectasis, where your airways are damaged and widen
Preparing for a pneumonectomy
You'll go through several steps to get ready for a pneumonectomy. Your care team will order additional tests to ensure the procedure is right for you and check your overall health. If you have cancer, these tests may also help with lung cancer staging to make sure that the cancer has not spread to other areas of the body.
The tests you'll need before a pneumonectomy could include:
- Blood tests
- Imaging tests, including chest X-ray, CT scan or PET scan
- Pulmonary function test
- Echocardiogram to check on your heart
- Ventilation-perfusion scan, also called a VQ scan
Preparing at home
There are also things you can do ahead of time at home to prepare for your pneumonectomy. Talk with your surgeon’s office about specific instructions for the following:
- Quitting smoking before surgery
- Stopping or adjusting medications
- Planning for a support person as you recover from surgery
- Including exercise in your daily routine
- Participating in pulmonary rehabilitation
- Using an incentive spirometer for breathing exercises
- Avoiding eating or drinking the night before and the morning of surgery
What to expect during a pneumonectomy
A pneumonectomy is performed under general anesthesia, which means you’ll be asleep during your surgery. Most pneumonectomies use a traditional open surgical approach and take several hours. If you have an extrapleural pneumonectomy, your procedure may be longer than a standard pneumonectomy.
As a pneumonectomy procedure is a major surgery, you will initially recover in the hospital. Most people spend five to 10 days in the hospital after their procedure.
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Before a pneumonectomy
Before a pneumonectomy
When you arrive on the day of your surgery, you’ll receive an IV drip and have several monitors placed on your body to track your vital signs—like blood pressure, oxygen levels and heart rate—during surgery. You will talk with your nurse, surgeon and anesthesia provider and sign consent forms for your procedure. If you have any concerns or questions, let your care team know.
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During a pneumonectomy
During a pneumonectomy
In the operating room, you’ll be asked to lie on your side, and your provider will give you anesthesia. Your care team will also place you on a temporary ventilator during surgery. Then, your surgeon will make an incision between two ribs from the side of your chest, under your arm and around your back.
To access the lung that will be removed, your surgeon may spread your ribs apart or remove part of your rib. Your lung will be deflated and removed, and your surgeon will close off blood vessels and the bronchus that were connected to the lung. Depending on your procedure, other tissues or lymph nodes may be removed.
At the end of your procedure, a chest tube is often left to help drain fluid and air afterward. Your surgeon will close up the incision, and you’ll go to the intensive care unit.
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After a pneumonectomy
After a pneumonectomy
Immediately after your pneumonectomy, your team will carefully monitor you as you wake up from surgery. When you wake up, it's normal to have a tube in your nose for oxygen and other tubes and monitors on your body.
As you recover in the hospital, several team members will care for you. You may see a respiratory therapist and use an incentive spirometer to help keep your remaining lung healthy. A physical or occupational therapist may visit you to get you up and moving. Your nursing team will also help you manage your pain, keep you as comfortable as possible and make sure you understand how to care for yourself once you go home.
When it's time to leave the hospital, you'll need a support person to drive you home and help you in the days following your hospital stay. Follow your doctor's instructions about activity limitations, diet, exercise, wound care, pulmonary rehabilitation and follow-up visits. After a pneumonectomy, it may take a few months before you feel like yourself again.
Before a pneumonectomy
When you arrive on the day of your surgery, you’ll receive an IV drip and have several monitors placed on your body to track your vital signs—like blood pressure, oxygen levels and heart rate—during surgery. You will talk with your nurse, surgeon and anesthesia provider and sign consent forms for your procedure. If you have any concerns or questions, let your care team know.
During a pneumonectomy
In the operating room, you’ll be asked to lie on your side, and your provider will give you anesthesia. Your care team will also place you on a temporary ventilator during surgery. Then, your surgeon will make an incision between two ribs from the side of your chest, under your arm and around your back.
To access the lung that will be removed, your surgeon may spread your ribs apart or remove part of your rib. Your lung will be deflated and removed, and your surgeon will close off blood vessels and the bronchus that were connected to the lung. Depending on your procedure, other tissues or lymph nodes may be removed.
At the end of your procedure, a chest tube is often left to help drain fluid and air afterward. Your surgeon will close up the incision, and you’ll go to the intensive care unit.
After a pneumonectomy
Immediately after your pneumonectomy, your team will carefully monitor you as you wake up from surgery. When you wake up, it's normal to have a tube in your nose for oxygen and other tubes and monitors on your body.
As you recover in the hospital, several team members will care for you. You may see a respiratory therapist and use an incentive spirometer to help keep your remaining lung healthy. A physical or occupational therapist may visit you to get you up and moving. Your nursing team will also help you manage your pain, keep you as comfortable as possible and make sure you understand how to care for yourself once you go home.
When it's time to leave the hospital, you'll need a support person to drive you home and help you in the days following your hospital stay. Follow your doctor's instructions about activity limitations, diet, exercise, wound care, pulmonary rehabilitation and follow-up visits. After a pneumonectomy, it may take a few months before you feel like yourself again.
Risk and complications
Most people who have a pneumonectomy have a smooth recovery. However, pneumonectomy is a major surgery, and it is considered a higher-risk surgery than other less invasive options. This procedure benefits people with serious lung conditions, but your doctor will discuss whether these benefits outweigh any potential risks or complications.
Some of the risks of pneumonectomy include:
- A blood clot in the lung, called pulmonary embolism
- Respiratory failure
- Infections, including pneumonia
- Heart issues, such as heart attack or arrhythmia
- Excessive bleeding
- Air leak in the chest
- Post-pneumonectomy syndrome, where organs shift too much in the chest after a lung is removed and block the airway.
- An abnormal connection between the bronchus and the chest cavity
- Injury to nearby tissues, including the diaphragm, trachea, vocal cords or blood vessels.
- Shock
- Side effects from anesthesia
Frequently asked questions
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What happens to the lung after pneumonectomy?
An adult lung can’t regrow after it’s removed during a pneumonectomy, but fluid will eventually fill the space. Other nearby organs, like the diaphragm or heart, may also shift in the chest. In some cases, your other lung may expand, too.
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Can a person survive with one lung?
Yes. In most people, one healthy lung can provide enough oxygen to the body and take away carbon dioxide. Because you’ll have a reduced lung capacity, you may have side effects like shortness of breath, but your lung should still function well enough to keep you healthy.
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How long does it take to recover from a pneumonectomy?
Within six to eight weeks after a pneumonectomy, your chest pain and soreness should improve, and you may be able to return to most activities, such as work. However, it may take several months to feel completely recovered and back to yourself.
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How is pneumonectomy different from lobectomy?
A pneumonectomy is a more extensive procedure than a lobectomy. When possible, your surgeon will choose a lobectomy, which only removes a lobe of the lung. A pneumonectomy removes the entire lung; it’s a more common surgery for cancer that has spread or is located toward the middle of the chest.
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Can you live a normal life after lung removal?
Yes. Most people can return to their normal pre-surgery self after their initial recovery from a pneumonectomy—usually in three to six months. The overall quality of life after a lung is removed depends on the person's quality of life and health before the procedure.