Pneumonectomy

January 24, 2025

This page was reviewed under our medical and editorial policy by Jyoti Malhotra, M.D., M.P.H., associate professor, Department of Medical Oncology & Therapeutics Research, City of Hope^® Orange County Lennar Foundation Cancer Center; and Jae Y. Kim, M.D., associate professor, Division of Thoracic Surgery, Department of Surgery, City of Hope Cancer Center Duarte

A pneumonectomy is a type of surgery in which an entire lung is removed. It is most commonly used to treat certain lung cancers or mesothelioma, a rare cancer that starts in the lining of the chest or abdomen.

The care team may recommend this procedure to help eliminate cancerous tissue. It may also be used alongside other treatments, such as chemotherapy, radiation therapy or lung cancer immunotherapy, as part of a comprehensive treatment plan.

What Is a Pneumonectomy?

The main goal of removing a lung via a pneumonectomy is to eliminate as much cancerous tissue as possible.

While losing a whole lung might sound scary, many people are able to live quite well with just one healthy lung. The remaining lung adapts and takes on more of the breathing work.

This procedure is usually considered when the cancer is located in central areas of the lung, such as the main airway (bronchus), or when it has spread extensively within the lung. Non-small cell lung cancer is the most common type that may require a pneumonectomy. It is typically recommended when less extensive surgeries are unable to remove the cancer as successfully.

Sometimes, a more extensive surgery called an extrapleural pneumonectomy is performed. This surgery removes not only the lung, but also parts of the lining of the chest (pleura), diaphragm and nearby lymph nodes.

If the remaining lung is healthy after surgery, many patients are able to maintain normal oxygen levels and may return to many of their usual activities.

Pneumonectomy Surgery

Before a pneumonectomy, patients undergo a thorough evaluation to make sure they are healthy enough for the procedure. This includes tests to measure lung function, such as spirometry, and assessments of how well the lungs transfer oxygen into the blood. The care team also checks the patient’s heart health using tests like electrocardiograms (EKGs) or echocardiograms to minimize the risk of complications.

On the day of the operation, the patient receives general anesthesia and remains asleep throughout the procedure. To help manage pain afterward, an anesthesiologist might place a thoracic epidural before surgery begins. This is a pain management technique in which doctors place a small catheter near the spinal cord in the upper back to deliver medication that helps control pain during and after surgery. 

The patient is then positioned on his or her side — this is called the lateral decubitus position — with the side of the lung being removed facing upward. This position gives the surgeon better access to the lung.

Different surgical methods might be used. In an open surgery called a thoracotomy, the surgeon makes a large incision between the ribs to reach the lung. The lung is deflated to make it easier to remove. The surgeon may also remove nearby lymph nodes to see if the cancer has spread. This procedure may take anywhere from two to six hours.

Alternatively, minimally invasive techniques like video-assisted thoracoscopic surgery or robotic surgery use smaller incisions and special instruments, often resulting in less pain and a quicker recovery.

In some cases, an extrapleural pneumonectomy is performed. This is a more extensive surgery in which the surgeon removes not only the lung, but also parts of the lining of the chest cavity (pleura), the diaphragm (the muscle that helps with breathing) and possibly the pericardium (the sac around the heart). After removing these tissues, the diaphragm and pericardium are reconstructed using artificial materials.

After the lung is removed, one or more chest tubes are placed to drain fluids and help the chest heal properly. Patients should expect to stay in the hospital for several days, during which medical staff will closely monitor their recovery.

Procedure Recovery

Immediately after surgery, the patient is usually taken to the intensive care unit (ICU) for close observation. Medical staff monitor the patient’s vital signs and make sure breathing remains stable. The breathing tube used during surgery is removed before the patient leaves the operating room to reduce the risk of lung complications.

Pain management begins right away, often using a combination of medications delivered through an intravenous (IV) line or an epidural catheter, a small tube placed near the spinal cord to provide continuous pain relief.

The hospital stay typically lasts five to seven days. During this time, nurses encourage sitting up and walking as soon as possible to promote lung expansion and prevent blood clots. Deep breathing exercises help inflate the remaining lung and prevent infections like pneumonia.

Once discharged, recovery continues at home for about six to eight weeks. The patient may experience pain when moving the arm, twisting the upper body or taking deep breaths, but this should gradually improve.

Patients should avoid lifting heavy objects for several weeks. Light activities like walking are encouraged. Patients should start with short distances and slowly increase as strength returns. Climbing stairs is acceptable but should be done slowly and carefully.

Household tasks may be resumed gradually, beginning with light chores after a few weeks. Patients should avoid strenuous activities such as yard work or using heavy equipment for at least four to eight weeks.

Patients should avoid driving while taking pain medications that cause drowsiness. Depending on the patient’s recovery and the physical demands of his or her job, it may be possible to return to work anywhere from four to eight weeks after surgery. Patients should talk with their surgeon for personalized advice.

Pneumonectomy Complications

Pneumonectomy is a major surgery, so it is important to understand the potential complications. One common issue is an irregular heartbeat, specifically atrial fibrillation or flutter. This typically occurs within the first three days after surgery and is usually managed with medication.

A rare but serious complication is postpneumonectomy cardiac herniation, in which the heart shifts from its normal position due to changes in the chest cavity. This may lead to a sudden drop in blood pressure and requires immediate medical attention and possibly another surgery.

Pulmonary complications like pneumonia (a lung infection), atelectasis (collapse of part of the lung) and respiratory failure are also possible. These are more common in older patients and may require the use of a ventilator to assist with breathing.

There is also a risk of injury to nearby organs during surgery, such as the diaphragm (the muscle that helps with breathing), liver, spleen or major blood vessels.

Postpneumonectomy pulmonary edema occurs when fluid accumulates in the remaining lung, typically two to three days after surgery. It may cause difficulty breathing and low oxygen levels. Treatment includes supportive care with oxygen therapy, careful fluid management and sometimes medicine to remove excess fluid.

One delayed complication, postpneumonectomy syndrome, may occur well after recovery. This occurs when the remaining lung overexpands, shifting the chest structures and twisting the main airway. Symptoms include increased shortness of breath and frequent infections. The treatment for this condition is surgery to correct the position of the chest organs.

Pneumonectomy Versus Lobectomy

A pneumonectomy and a lobectomy are two surgical procedures used to treat lung conditions like cancer. They differ in the amount of lung tissue removed.

Pneumonectomy: For this procedure, the surgeon removes an entire lung. This is typically necessary when the lung cancer is widespread within the lung or centrally located, making less extensive surgery insufficient.

Lobectomy: This operation involves removing only a lobe of the lung — the large sections that make up each lung. The right lung has three lobes, and the left lung has two. Each of these lobes is further divided into smaller units called segments. When cancer is confined to a specific lobe, removing just that lobe may be an appropriate treatment.

Sometimes, surgeons opt for even less extensive surgery, such as a segmentectomy or wedge resection, where only a part of a lobe or a small wedge-shaped piece of lung tissue is removed. This approach, also known as lung-sparing surgery, is becoming more common, especially for patients with very early-stage tumors detected through screening programs.

Choosing between a pneumonectomy and a lobectomy depends on several factors, including the size and location of the tumor, the stage of the disease and the patient’s overall health.