Pneumonectomy

What does a pneumonectomy involve?

During surgery you lie on your side with your arm raised. Open surgery (thoracotomy) is done with one larger incision under the shoulder blade, the incision goes between two ribs. The two ribs are parted to access the chest. One rib may be cut to give more space, ribs are not removed.

The blood vessels and bronchus leading to the lung identified. Special stapling devices are used to cut and seal the blood vessels and bronchus. Sutures 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 two ribs are held back together with loops of sutures. The muscles and skin are sutured in layers.

one chest drain is positioned at the end of the operation and secured in placed with a stitch. This is used to monitor for bleeding or air leak. Your chest drain will be intermittently clamped and unclamped. 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 removal of more lung tissue than other operations so your recovery may take longer than the quoted timescales. Most people go within two weeks of surgery. Everyone recovers at a different pace; do not worry if you need more time.
You will experience 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.

Your GP is likely to recommend having an annual flu vaccination after pneumonectomy.

What are the risks?

 General risks of thoracic surgery apply to pneumonectomy.

In addition the following are risks of pneumonectomy are:

• shortness of breath

If you already have lung disease there is a higher risk of being severely breathless, including needing to have oxygen at home.

• broncho-pleural fistula

A hole may form in the bronchus, this is called a broncho-pleural fistula. This is most common with an infection. You will need to have a chest drain re-inserted and antibiotics. You are may need another operation to fix the hole.

• renal failure

This is usually temporary and improves with fluids.

• respiratory failure

Shortness of breath may severe enough to require help from a ventilator machine. This can be via a face mask with you fully awake, known as non-invasive ventilation (NIV). It may also be need via a tube in the trachea with you under sedation. If you need help breathing via a tube in the trachea for a longer period it may be beneficial to have a temporary tracheostomy.

• death

The risk of death from pneumonectomy is one in 20 nationally. This is considered a high risk operation.

• chyle leak

This is fatty fluid into the chest, it is very rare. You may require a temporary change in diet or another operation to treat this.

• post-pneumonectomy syndrome

This is rare. You may require another operation to get rid of the symptoms. The symptoms include increased shortness of breath, difficulty swallowing and fainting.

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 surgeon, your lung cancer nurse and your respiratory physician. If you do not want surgery or are not fit enough to have an operation other options may include:

• radiotherapy
• chemotherapy
• palliative care

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

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.