Sometimes, due to diseases that affect our lungs, especially serious conditions like cancer, doctors have to make a very serious decision. In such cases, the entire lung with the disease may have to be surgically removed. This is what we call a 'Pneumonectomy' in medicine. Since this is a major surgery, it is very important for you to know exactly what to expect.
What exactly is a pneumonectomy?
Simply put, a pneumonectomy is the surgical removal of one of your lungs. If the right lung is removed, it is called a 'right-sided pneumonectomy', and if the left lung is removed, it is called a 'left-sided pneumonectomy'.
This is the largest type of lung surgery, as there are sometimes surgeries that only remove a small piece of the lung.
- (Lobectomy) - This involves removing only a portion (lobe) of the lung.
- (Wedge resection) - In this, an even smaller piece of the lung is removed.
Pneumonectomy surgery is performed in two main ways.
| Type of surgery | Description |
|---|---|
| Standard Pneumonectomy | In this, the surgeon removes only your entire lung. He may also remove some of the nearby nerves and tissue. |
| Extrapleural Pneumonectomy (more extensive surgery) | This is a bit more complicated. In addition to the lungs, several other things are removed. That is: - Lungs - The covering around the lungs (Pleura) - The covering around the heart (pericardium) - A portion of the diaphragm is also removed. |
Surgeons use two methods to perform this surgery. One is an open surgery called a thoracotomy . The other is a small incision surgery called a video-assisted thoracic surgery (VATS) . Although VATS is less invasive, it is not suitable for all patients.
What types of conditions is this surgery performed for?
This surgery is most often performed as a treatment for lung cancer, but it can also be performed for other conditions.
- Lung cancer
- Carcinoid tumors that form in the lungs
- Pleural mesothelioma, a cancer that forms in the lining of the lungs
- Severe lung injuries
- A serious fungal infection called Aspergillosis
- Bronchiectasis is a disease in which the airways become permanently dilated.
- Tuberculosis
- When a type of cancer called disseminated thymoma spreads
Pneumonectomy is the most common treatment for lung cancer, but not all cancer patients can undergo this procedure.
Who is this surgery suitable for?
You may be eligible for this surgery in the following cases:
- If the cancer is in only one lung (and has not spread to other areas) and the lung can be removed and the cancer can be completely cured.
- Depending on the location of the cancerous tumor, only a piece of the lung can be removed and the entire tumor cannot be removed.
- If your heart, blood vessels, and other organs are in good health.
Who is not suitable for this surgery?
- For those who do not have sufficient lung function.
- For those with severe heart valve disease.
- For those with severe pulmonary hypertension (high pressure in the blood vessels that carry blood to the lungs).
- For those with poor heart pumping ability (Poor ventricular function).
Pre-surgery and preparation for surgery
A few days or weeks before surgery, your doctor will do some tests to see how your heart and lungs are working.
- (VQ scan)
- Pulmonary function tests
- Heart (Echocardiogram) test
- Chest X-ray
- (PET scan) and (CT scan)
- Blood tests
How should you prepare?
Since this is a major surgery, you need to prepare well in advance.
- Arrange for someone to take care of the housework and pets while you are in the hospital.
- Talk to someone to come pick you up when you get home from the hospital.
- It's very important to have someone to help you for a while after you get home. Plan for that too.
- If you smoke, stop immediately. This is very important. If you are having trouble quitting, ask your doctor for help.
- Tell your doctor about all the medications you are taking. He or she may ask you to stop taking some medications or change the timing before surgery.
- If you have any allergies to medications, tell us about them as well.
- The doctor will tell you not to eat or drink anything after midnight the night before the surgery. Follow those instructions exactly.
What happens during and after the surgery?
During the operation, you will be completely anesthetized, so you will not feel anything. The anesthesiologist will monitor you throughout the operation. The surgeon will make an incision in the side of your chest, between two ribs, and move the ribs apart to reach the lung. Then, the surgeon will remove some of the air from the lung and carefully remove it. If necessary, other tissue will be removed, and the ribs, muscles, and skin will be sewn back together. This operation can take several hours.
After the surgery...
After the surgery, you will have to stay in the hospital for a few days.
- The medical team will continue to monitor your oxygen levels, heart rate, and blood pressure.
- Painkillers will be given to control the pain.
- Physical therapists will come and teach you breathing exercises, help you get out of bed and walk.
What happens to that empty space when the lung is removed?
This is a problem that many people have. As soon as a lung is removed, the space fills with air. After a while, that air is replaced by fluid. Over time, your heart, diaphragm, and other organs are pushed in that direction. The remaining lung also gets a little bigger. Our bodies adapt to this new situation in a wonderful way.
What are the benefits and risks of surgery?
| Benefits | Risks & Complications |
|---|---|
| In the case of cancer, the entire tumor can be removed to stop the cancer from spreading, and it may even be completely cured. | Chest abscess (Empyema) |
| It can prevent fatal infections (bacteria, fungi) that can occur due to a damaged lung. | Heartbeat irregularities (Arrhythmia) |
| Respiratory failure | |
| Pneumonia | |
| Pulmonary embolism | |
| Bronchopleural fistula (hole between the trachea and the lining of the lung) | |
| There is a risk of cancer reoccurring even after surgery. |
Important: Due to the structure of the body, the risk of complications during surgery to remove the right lung is slightly higher than the left.
Recovery and life ahead
It may take several months to fully heal. During this time:
- There are restrictions on things like lifting weights and driving.
- Feeling more tired than usual.
- You need to rest regularly.
- It may be difficult to perform normal daily tasks.
Some of these will go away as you heal, and some things may become part of your "new normal."
What can be said about life span?
This depends on many factors. The main reason for the surgery is the reason for which it was performed. For example, more than 3 out of 4 people who have surgery for tuberculosis live for more than 10 years. However, surveys show that only 1 out of 3 people who have surgery for lung cancer live for more than 5 years. Therefore, it is important to discuss your situation with your doctor.
When to seek medical advice
Pay close attention to changes in your body during your recovery.
| If you have these symptoms, call your doctor immediately. | |
|---|---|
| - If the bandage on the surgical wound becomes wet with blood. | - If the wound has a foul odor or a different colored fluid coming out. |
| - A cough with excessive mucus or mucus that is discolored. | - Fever. |
| - Nausea or vomiting. | - Pain that doesn't go away even after taking medicine. |
| If you have these symptoms, go to the hospital's ETU (Emergency Treatment Unit) immediately. | |
| - If you are coughing up blood. | - Severe difficulty breathing. |
| - Sudden chest pain with difficulty breathing. | - Loss of consciousness. |
Take-Home Message
- Pneumonectomy is a very serious surgery. It is only performed in extreme cases, when there are few other treatment options.
- It takes several months to fully recover from surgery, and it is important to be patient during this time.
- Although it is possible to live with one lung for a long time, some lifestyle changes will be required.
- Feel free to discuss any questions or concerns you may have before or after surgery with your doctor. Only then can you make the best decision for your health.
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