Lung Removal (Pneumonectomy)

Your doctor may recommend lung removal to treat:

• Lung cancer, which is the most common reason for removing a lung. Lung removal may be necessary when removing a smaller portion of the lung won’t treat the cancer.

• Severe, chronic lung infection, such as fungal infections, multiple lung abscesses, or tuberculosis, when other treatments fail

• Severe, congenital lung disease, which is a lung defect present at birth 

• Traumatic injury, when the injury is extreme and there are no other treatment options

A thoracic surgeon performs lung removal. Thoracic surgeons specialize in surgery of the chest, including the blood vessels, heart, lungs, and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons because thoracic surgeons can also operate on the heart.

Your surgeon will perform your lung removal in a hospital using one of the following approaches:

• Video-assisted thoracoscopic surgery (VATS) is minimally invasive. Your surgeon will insert special instruments and a thoracoscope through small incisions in your chest. The thoracoscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your surgeon sees the inside of your chest on the video screen while performing surgery. VATS generally involves a faster recovery and less pain than open surgery. However, this procedure may not be available at all surgical centers. High-volume centers are more likely to offer minimally invasive options.

• Open surgery (thoracotomy) involves making a large incision in the chest between the ribs. Thoracotomy allows your surgeon to directly view and access the surgical area. Open lung surgery generally involves a longer recovery and more pain than minimally invasive lung surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain people.
  

It is possible your surgeon may decide after beginning a VATS procedure that you require an open surgery to safely and most effectively complete your surgery. 

Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different lung removal procedures and ask why your surgeon will use a particular type for you.

Types of anesthesia that may be used

Your doctor will perform lung removal surgery using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You will not feel any pain. You may also have an epidural catheter (regional anesthesia) to help with pain during and after the procedure.

What to expect the day of your lung removal surgery

The day of your surgery, you can expect to:

• Talk with a preoperative nurse. The nurse will perform an exam and ensure all necessary tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

• Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.

• Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.

• A surgical team member will start an intravenous (IV) line. 

• The anesthesiologist or nurse anesthetist will start your anesthesia.

• A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

• The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

As with all surgeries, lung removal involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

General risks of surgery

The general risks of surgery include:

• Anesthesia reaction, such as an allergic reaction and problems with breathing

• Bleeding, which can lead to shock

• Blood clot, in particular a deep vein thrombosis (DVT). A DVT can dislodge, traveling to a lung causing a pulmonary embolism.

• Infection

Complications of lung removal include:

• Abnormal heart rhythm

• Buildup of fluid in the space left by the lung

• Collapsed lung

• Leakage of air into the chest between the lung and the chest wall

• Moving of organs and tissue into the space left by the lung

• Respiratory failure and death
  

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

• Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery.

• This may include consultation with a registered dietitian.

• Informing your doctor if you are nursing or there is any possibility of pregnancy

• Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage

• Taking your medications exactly as directed

• Telling all members of your care team if you have any allergies

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.

You can prepare for lung removal by:

• Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

• Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a CT scan, EKG (electrocardiogram), blood tests, and other tests as needed.

• Losing excess weight before the surgery through a healthy diet and exercise plan

• Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

• Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

• Taking or stopping medications exactly as directed. 

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

• Why do I need lung removal? Are there any other options for treating my condition?

• What type of lung removal procedure will I need?

• How long will the procedure take? When can I go home?

• What restrictions will I have after the surgery? When can I return to work and other activities?

• What kind of assistance will I need at home?

• What medications will I need before and after the surgery? How should I take my usual medications? 

• How will you treat my pain?

• What type of rehabilitation and physical therapy will I need?

• When should I follow up with you?

• How should I contact you? Ask for numbers to call during and after regular hours.

Knowing what to expect can help make your road to recovery after lung removal as smooth as possible. 

How long will it take to recover?

You will be in an intensive care unit (ICU) after surgery. ICUs provide 24-hour intensive monitoring of all your body systems. How long you need to stay in the hospital varies depending on your age, medical history, diagnosis, and other factors.

You will have a chest tube when you wake up from surgery. This is a tube that comes out through your chest to drain fluids, blood and air. You team will remove the tube as soon as possible. Until then, the team will keep you comfortable with pain medications and a mild sedative.

You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.

Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, your age, and other factors. You will need to avoid strenuous activity for 6 to 8 weeks after surgery. 

During this time, you will likely have physical therapy and other therapies to help you recover. Rehabilitation therapies help your body compensate for the loss of a lung. They can improve circulation, endurance, strength, and lung capacity. Tell your doctor and therapists about all your activities and follow their instructions for returning to them.

Will I feel pain?

Pain control is important for healing and a smooth recovery. You will have some pain after surgery and breathing may be uncomfortable. Your doctor will treat your pain so you are comfortable and can get the rest you need. Tell your care team or your doctor if your pain gets worse or changes because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up appointments after lung removal. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

• Bleeding

• Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

• Change alertness, such as passing out, unresponsiveness, or confusion

• Chest pain, chest tightness, chest pressure, or palpitations

• Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

• Inability to urinate or have a bowel movement

• Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot

• Pain not controlled by your pain medication, new pain, or pain that changes

• Severe nausea and vomiting

• Unexpected drainage, pus, redness or swelling of your incision

How might lung removal affect my everyday life?

Lung removal may cure your condition so you can lead the most active, healthy life possible. However, many people have ongoing shortness of breath. This can occur even without exertion. You may need supplemental oxygen during certain activities and restrict the kinds of work and activities you do. Each case is different, so follow your doctor’s advice about your activities.