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Thoracic Surgery

Pneumonectomy

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Pneumonectomy is the surgical removal of a lung, usually for the purpose of treating cancer or chronic obstructive pulmonary disease (COPD).

In most cases, a mechanical ventilator will help you breathe, either on a temporary or permanent basis.

The Surgery

The surgeon makes a large incision (thoracotomy) on the same side of the chest as the diseased lung. This incision extends from a point below the shoulder blade around the side of the patient's body along the curvature of the ribs at the front of the chest. Sometimes the surgeon removes part of the fifth rib in order to have a clearer view of the lung and greater ease in removing the diseased organ.

A surgeon performing a traditional pneumonectomy then:

  • deflates the diseased lung
  • ties off the lung's major blood vessels to prevent bleeding into the chest cavity
  • clamps the main bronchus to prevent fluid from entering the air passage
  • cuts through the bronchus
  • removes the lung
  • staples or sutures the end of the bronchus that has been cut
  • makes sure that air is not escaping from the bronchus
  • inserts a temporary drainage tube between the layers of the pleura to draw air, fluid, and blood out of the surgical cavity
  • closes the chest incision

The surgery usually lasts one to three hours.

Recovery is usually a slow process, with the remaining lung gradually taking on the work of the lung that has been removed. You may gradually resume normal non-strenuous activities. If you do not experience postoperative problems, you may be well enough within eight weeks to return to a job that is not physically demanding; however, 60% of all pneumonectomy patients continue to struggle with shortness of breath six months after having surgery.

Risks Associated with Pneumonectomy

The risks for any surgical procedure include bleeding and infection.

Between 40% and 60% of pneumonectomy patients experience such short-term postoperative difficulties as:

  • prolonged need for a mechanical respirator
  • abnormal heart rhythm (cardiac arrhythmia); heart attack (myocardial infarction); or other heart problem
  • pneumonia
  • infection at the site of the incision
  • a blood clot in the remaining lung (pulmonary embolism)
  • an abnormal connection between the stump of the cut bronchus and the pleural space due to a leak in the stump (bronchopleural fistula)
  • accumulation of pus in the pleural space (empyema)
  • kidney or other organ failure
  • Over time, the remaining organs in the patient's chest may move into the space left by the surgery. This condition is called postpneumonectomy syndrome; the surgeon can correct it by inserting a fluid-filled prosthesis into the space formerly occupied by the diseased lung.

For important information on the general risks of and preparation for thoracic surgery, please see Before Thoracic Surgery.

For post-operative information, please see After Thoracic Surgery.

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