What Is a Pneumonectomy for Lung Cancer?

What to expect when undergoing a pneumonectomy for lung cancer

A pneumonectomy is a type of lung cancer surgery in which an entire lung is removed as a treatment for lung cancer. Occasionally, it may also be performed for other conditions such as tuberculosis, severe COPD, or trauma that interrupts major blood vessels near the lungs.

While a pneumonectomy is a major surgical procedure, you can live a full, active life with one lung by making some lifestyle adjustments. There are other surgical options for lung cancer that are less invasive, including wedge resection and lobectomy These may not be appropriate for your condition, however. Once you and your doctor have determined that a pneumonectomy is the right treatment for you, take time to learn about the procedure, possible complications, and what the path to recovery will look like.

Purpose of a Pneumonectomy

A pneumonectomy is most commonly done as a treatment for non-small cell lung cancer that hasn't spread outside of lung tissue. Typically, it's only recommended when a less invasive procedure cannot remove the entire tumor. Your doctor may recommend removing one entire lung for several reasons:

  • The tumor is too large to be cut away from the lung tissue, as is done with other types of lung cancer surgery.
  • Tumors have spread and are significantly affecting the pulmonary artery or airways.
  • Tumors are in the middle of a lung (near the hilum) and can't be reached via a wedge resection or lobectomy.

The procedure is usually reserved for those who will have adequate lung function in the remaining lung and will be able to tolerate living with only one lung.

Pneumonectomy in Older Adults

When choosing treatments for older adults with lung cancer, a pneumonectomy is often discouraged because there's a very low survival rate for those over 70. However, research shows that these patients aren't any more likely to have complications during surgery, so when other types of operations wouldn't be successful, older adults should not be denied lung-removal surgery because of their age. It may offer the best chance for improving their quality of life and enjoying more time with family and friends.

Types of Pneumonectomy

There are two main types of pneumonectomy procedures that doctors perform for lung cancer treatment:

  • Standard Pneumonectomy: One lung is completely removed, either the right lung (which contains 3 lobes) or the left lung (containing 2 lobes).
  • Extrapleural Pneumonectomy: One lung is removed along with part of the diaphragm, the membrane lining the chest cavity (the pleura), and part of the membrane lining the heart (the pericardium). This procedure is most often done for mesothelioma, a form of cancer that begins in the lining surrounding the lungs.

Risks and Contraindications

Because it is a major medical procedure, a pneumonectomy for lung cancer does pose some risks. Your doctor will discuss these with you before your surgery.

Some potential complications may include:

  • Respiratory failure
  • Infections, such as pneumonia
  • Bleeding
  • Heart problems, such as a heart attack or abnormal heart rhythms
  • Blood clots in the legs (deep vein thrombosis) that can travel to your lungs (pulmonary embolism)
  • Problems related to anesthesia
  • Shock
  • Reduced blood flow to the heart

Studies of mesothelioma patients who have undergone extrapleural pneumonectomy procedures show that there are different risks depending on which lung is removed. Specifically, those who have their right lung removed are significantly more likely to develop bronchopleural fistula, the development of an abnormal passageway between the bronchi (the large airways in the lungs) and the space between the membranes that line the lungs.

In rare instances, patients may develop a condition called post-thoracotomy or postpneumonectomy syndrome in which their airway is obstructed as organs shift because of the space left vacant from the lung removal. This can result in long term pain. Researchers have been actively searching for effective ways to treat this problem and provide people who suffer from it with some relief via additional surgery.

Before a Pneumonectomy

In preparing for your pneumonectomy for lung cancer, you'll visit with your doctor and have several tests done to make sure the procedure is as successful as possible.

Tests to Confirm Stage and Rule out Metastases

Since surgery is not the usual treatment for lung cancer that has spread beyond the lungs, your doctor will recommend tests to rule out any metastasis (spread of cancer). These may include a bone scan to look for the spread of lung cancer to bone, a brain scan to rule out brain metastases, and an abdominal scan to rule out liver metastases and adrenal metastases.

Tests to Evaluate Lung Function

Tests will then be done to make sure you will be able to tolerate living with only one lung. Pulmonary function tests will evaluate your healthy lung and determine its ability to deliver adequate oxygen to your body alone.

General Health Evaluation

Your doctor may also recommend tests to make sure your heart is functioning well since surgery can add stress to the heart. A careful history, physical exam, and lab work will be done to make sure you are as healthy as possible.

It's very helpful to bring a list of questions with you to preoperative appointments to make sure any concerns you have are not overlooked.

Pulmonary Rehabilitation

If you have time to pursue pulmonary rehabilitation prior to your pneumonectomy, your surgeon may recommend this. According to research, preoperative pulmonary rehabilitation reduces the risk of surgical complications related to lung cancer surgery by half.

After studying the results of your tests, your doctor will carefully discuss the benefits and risks of surgery.

Before Your Surgery

If you are on any medications that can increase bleeding, such as Coumadin (warfarin). aspirin, or anti-inflammatory medications such as Advil (ibuprofen), your doctor will recommend discontinuing these for a period of time before your surgery. Make sure to let your doctor know if you are using any herbal remedies or nutritional supplements since some of these can thin your blood as well.

If you smoke, your physician will strongly recommend that you quit as soon as possible prior to your surgery. Studies have shown that lung cancer surgery is more successful and has fewer complications if people stop smoking beforehand.

The night before surgery, your doctor will recommend that you “fast”—that is, not eat or drink anything (even water) for at least 8 hours.

On the morning of your surgery, a nurse will ask you several questions and place an IV (intravenous line) in your arm. She will also fit you with monitors so that your blood pressure, heart rate, and oxygen levels can be monitored throughout surgery. Your surgeon will visit again to discuss the procedure and ask you to sign a consent form. The anesthesiologist will also visit to talk about the anesthesia you will be given, and ask about any problems you or your family members have experienced with anesthesia in the past. The operating room staff will guide your family to a waiting area where the surgical staff can keep them updated on your progress and speak with them when your surgery is done.

During the Procedure

In the operating room, you will be given a general anesthetic to put you to sleep, and an endotracheal tube will be placed through your mouth into your healthy lung to allow a ventilator to breathe for you during surgery.

A long incision will be made along your side following the curve of your ribs. The surgeon will spread your ribs and may remove a portion of a rib to gain access to your lung.

When your lung is adequately exposed, the surgical team will collapse your lung that contains the cancer. The major blood vessels (arteries and veins) traveling to your lung will be tied off, and the bronchus leading to the lung will be tied off and sewn shut.

After your lung is removed, the surgeon will carefully check to make sure all bleeding is controlled, and will then close the incisions.

The space remaining where your lung had been will gradually fill in with fluid.

A minimally invasive approach to lung cancer surgery called video-assisted thoracoscopic surgery (VATS) is often used for lobectomies. In cases where the surgeon is highly skilled, this procedure may be used to remove a lung. During VATS, several small incisions are made in the chest, and with the aid of a camera, the lung is removed with special instruments. While the recovery is usually easier with VATS, it is used primarily to removed early-stage tumors near the outside of the lung and only rarely for the removal of an entire lung.

After a Pneumonectomy

When your surgery is complete, you'll be taken to the recovery room where you will be monitored closely for several hours. In some cases, you may be taken directly to the intensive care unit (ICU).

Hospital Recovery

Most people spend the first several days in the ICU after a pneumonectomy. For the first day, your breathing may be assisted with a ventilator. Since this can cause some anxiety, you may continue to be lightly sedated until the tube is removed.

When the ventilator is removed and you become less sleepy, a respiratory therapist will ask you to cough and will assist you in the use of an incentive spirometer. This is a device that you breathe into in order to exercise your lungs and to help keep the small air sacs in your lungs open. Using an incentive spirometer can also reduce your risk of atelectasis, or partial collapse of your remaining lung after surgery.

When you are able, the nursing staff will help you sit and then encourage you to get up and walk with assistance. You want to take it slow, but gradually increasing your activity will help you regain your strength more quickly and will reduce the risk of developing blood clots. You will either have a pneumatic compression device (a contraption wrapped around your legs that repeatedly squeezes and lets go of your legs) or be given compression stockings to lower your risk of clots as well. While both the device and stockings can be uncomfortable, it's recommended that they are kept on whenever you are in bed until you are again active.

Returning Home

Most people spend at least 6 to 10 days in the hospital following surgery.

Some people return to work after 8 weeks, but your doctor will give you special restrictions, such as avoiding any heavy lifting. It will also take time for your remaining lung to take over, and shortness of breath may persist for several months following surgery.

Pulmonary rehabilitation may be recommended both before surgery and afterward while you recover, and may help to improve both your lung function and quality of life.

Exercise is not completely restricted after a pneumonectomy. In fact, researchers have found that post-operative high-intensity training can significantly improve lung function and oxygen intake.

When to Call Your Doctor

When you are released from the hospital, you will be given careful instructions on how to care for yourself at home and when to follow up with your doctor. Between appointments, you should call your doctor if you have any symptoms or questions that concern you. Call your doctor right away if you develop a fever, have chest pain that is different from what you have been experiencing, become increasingly short of breath, have any bleeding or redness near your incision, or if you develop any pain in your calves (possible blood clots).

Prognosis

The 5-year survival rate after a pneumonectomy is between 21% and 38%.

The prognosis depends on many factors. Some of these include:

  • Which lung is removed—the prognosis is better for a left pneumonectomy than a right pneumonectomy
  • The stage of the cancer
  • Gender—women tend to do better than men
  • The type of lung cancer—adenocarcinomas has a worse prognosis than squamous carcinomas
  • How healthy you are prior to surgery.

Recurrence of cancer in the healthy lung is not common after a pneumonectomy, but sometimes lung cancer may recur in distant regions of the body. Adjuvant chemotherapy may help improve long-term survival.

A Word From Verywell

If your doctor has recommended a pneumonectomy, you're probably feeling very anxious. It may be helpful to hear that many people are leading active lives with one lung, some even climbing mountains. Before considering a pneumonectomy, doctors are very careful to evaluate thoroughly whether a person is a good candidate for the procedure. If a pneumonectomy has been recommended, it's likely that your doctor believes you're in good health and will be able to tolerate the procedure and recover strong. While the procedure may seem fairly radical, for people who have tumors that cannot be removed completely through a smaller procedure such as lobectomy, surgery for lung cancer is the one treatment option that currently offers the best outcome.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Moffitt Cancer Center. Pneumonectomy: Surgery for Lung Cancer. Updated 2018.

  2. Kim TH, Park B, Cho JH, et al. Pneumonectomy for Clinical Stage I Non-Small Cell Lung Cancer in Elderly Patients over 70 Years of Age. Korean J Thorac Cardiovasc Surg. 2015;48(4):252-7. doi:10.5090%2Fkjtcs.2015.48.4.252

  3. Johns Hopkins Medicine. Pneumonectomy. Updated 2020.

  4. Batirel HF. Extrapleural pneumonectomy (EPP) pleurectomy decortication (P/D). Ann Transl Med. 2017;5(11):232. doi:10.21037%2Fatm.2017.03.82

  5. Purewal JK, Sakul NFN, Balabbigari NR, Nenninger A, Kotecha N. One Lung Soldier: A Ventilation Conundrum in a Postpneumonectomy Syndrome Complicated by Acute Respiratory Syndrome. Case Rep Pulmonol. 2020;2020:5476794. doi:10.1155/2020/5476794

  6. Steffens, D., Beckenkamp, P., Hancock, M., Solomon, M., and J. Young. Preoperative Exercise Halves the Postoperative Complication Rate in Patients with Lung Cancer: A Systematic Review of the Effect of Exercise on Complications, Length of Stay and Quality of Life in Patients with CancerBritish Journal of Sports Medicine. 2018. 52(5):344.

  7. Abebe W. Review of herbal medications with the potential to cause bleeding: dental implications, and risk prediction and prevention avenues. EPMA J. 2019;10(1):51-64.doi:10.1007%2Fs13167-018-0158-2

  8. Cataldo JK, Dubey S, Prochaska JJ. Smoking cessation: an integral part of lung cancer treatment. Oncology. 2010;78(5-6):289-301. doi:10.1159/000319937

  9. Ahmad AM. Essentials of Physiotherapy after Thoracic Surgery: What Physiotherapists Need to Know. A Narrative Review. Korean J Thorac Cardiovasc Surg. 2018;51(5):293–307. doi:10.5090/kjtcs.2018.51.5.293

  10. Edvardsen E, Skjønsberg OH, Holme I, Nordsletten L, Borchsenius F, Anderssen SA. High-intensity training following lung cancer surgery: a randomised controlled trial. Thorax. 2015;70(3):244-50. doi:10.1136/thoraxjnl-2014-205944

  11. Harvard Health Publishing Harvard Medical School. Pneumonectomy. Updated December 2019.

  12. Saha SP, Kalathiya RJ, Davenport DL, Ferraris VA, Mullett TW, Zwischenberger JB. Survival after Pneumonectomy for Stage III Non-small Cell Lung Cancer. Oman Med J. 2014;29(1):24-7. doi:10.5001%2Fomj.2014.06

  13. Gu C, Wang R, Pan X, et al. Comprehensive study of prognostic risk factors of patients underwent pneumonectomy. J Cancer. 2017;8(11):2097-2103. doi:10.7150%2Fjca.19454

Additional Reading
  • Devita, Hellman, and Rosenberg's Principles and Practice of Oncology. 11th edition. 2018.Wolters Klewers Health.