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What is pneumonectomy?

Pneumonectomy is removal of 1 whole lung, usually with the lymph glands around it.  The operation is done with you asleep via open surgery (thoracotomy). Surgery usually takes between one and three hours. The remaining lung will expand but there is still a space in the chest. This space fills with fluid.

What does pneumonectomy involve?
image012During surgery you lie on your side with your arm raised. Open surgery (thoracotomy) is done with one cut under the shoulder blade, the incision goes between 2 ribs. The 2 ribs are parted to get in to the chest. One rib may be cut to give more space, ribs are not removed.

The blood vessels and bronchus leading to the lung are identified. Special staples are used to cut and seal the blood vessels and bronchus. Stitches may be used instead of staples to seal the blood vessels and bronchus. If the operation is being done to treat lung cancer lymph glands will also be removed. At the end of surgery the 2 ribs are held back together with strong stitches. The muscles and skin closed with stitches.

One chest drain is put in at the end of the operation and held in placed with a stitch. Your chest drain will be clamped and unclamped at first, this is to check for any bleeding. The drain is usually removed 24 hours after surgery.

What is recovery like?
Recovery in hospital and recovery at home apply to recovery after pneumonectomy. Pneumonectomy involves removing more lung tissue than other operations so your recovery may take longer than the quoted timescales. Most people go home within 2 weeks of surgery. Everyone recovers at a different pace; do not worry if you need more time.

You will experience some shortness of breath after pneumonectomy. This should slowly improve with time and you can return to normal activity. You will need to do things at a slower pace than before surgery.

See sections on:

Pain control Exercise and physiotherapy
What are the risks?
Possible complications  of thoracic surgery apply to pneumonectomy.

In addition the following are risks of pneumonectomy:

  • Minor more common risks

Your kidneys may not work as well after surgery but this is usually temporary and gets better with extra fluid.

  • Major less common risks

As mentioned above you will feel short of breath at first. If you already have lung disease there is a higher risk of being severely breathless, including needing to have oxygen at home.

Shortness of breath may severe enough to require help from a ventilator machine. This can be with a face mask with you fully awake. It may also be need via a tube in your windpipe with you under sedation. If you need help breathing via a tube for a long time it may be better to have a temporary tracheostomy. This is a tube put in through the neck which is removed once breathing improves.

A hole may form near the staples (bronchopleural fistula), this is usually only happens with an infection. It causes air to keep coming out of the lung but can be difficult to diagnose.  You may need antibiotics and another operation to fix the hole.

Fatty fluid may collect in the chest (chyle leak), it is rare. You may require a temporary change in diet, a chest drain  or another operation to treat this.

This operation is considered high risk. Nationally 19 in 20 people are alive 1 month after surgery and 1 person dies. Your individual risk may be higher or lower depending on your  health.

Some rare symptoms may happen after pneumonectomy, including sudden increased shortness of breath, difficulty swallowing and fainting. You may require another operation to get rid of the symptoms.

What are the alternatives to surgery?
Surgery gives the best chance of becoming free from cancer if you have early stage lung cancer. You can discuss treatment options with your hospital doctors, your Lung Cancer Nurse and your GP. If you do not want surgery or are not fit enough to have an operation other options may include:

  • Radiotherapy
  • Chemotherapy
  • Palliative care

It is your choice whether to go ahead with surgery or choose another kind of treatment. We will respect your wishes and support you in choosing the treatment that suits your individual circumstances. You are always welcome to seek a second opinion.

Pneumonectomy may be done as an emergency, this is a lifesaving procedure to control bleeding.