Pneumonectomy Health Article

Definition

Pneumonectomy is the surgical removal of a lung.

Purpose

Pneumonectomy is most often used to treat lung cancer when less radical surgery cannot achieve satisfactory results. It also may be the most appropriate treatment for a tumor that is located near the center of the lung and that affects the pulmonary artery or veins, which transport blood between the heart and lungs. For the treatment of cancer, pneumonectomy may be combined with chemotherapy or radiation therapy. Pneumonectomy may also be the treatment of choice when traumatic chest injury has damaged the main air passage (bronchus) or the lung's major blood vessels so severely that they cannot be repaired. A form of this procedure known as extrapleural pneumonectomy is often used to treat malignant mesothelioma.

Precautions

Before scheduling a pneumonectomy, the surgeon reviews the patient's medical and surgical history and orders a number of tests to determine how successful the surgery is likely to be.

Blood tests, a bone scan, and computed tomography (CT) scans of the head and abdomen reveal whether the cancer has spread beyond the lungs. Positron emission tomography scanning (PET) is also used to help "stage" the disease. Cardiac screening indicates how well the patient's heart will tolerate the procedure, and extensive pulmonary testing (breathing tests and quantitative ventilation/perfusion scans) predicts whether the remaining lung will be able to compensate for the body's diminished breathing capacity.

Because extrapleural pneumonectomy is such an invasive operation, the patient must have no serious illness other than the cancer the surgery is designed to treat.

Description

Traditional pneumonectomy removes only the diseased lung. A more complex surgery generally performed in specialized medical centers, extrapleural pneumonectomy also removes:

• a section of the membrane (pericardium) covering the heart
• a portion of the muscular partition (diaphragm) that separates the chest and abdomen
• the membrane (parietal pleura) that lines the affected side of the chest cavity

General anesthesia is given to a patient undergoing either of these procedures. An intravenous (IV) line inserted into one arm supplies fluids and medication throughout the operation, which usually lasts between one and three hours; extrapleural pneumonectomies may last up to six hours.

The surgeon begins the operation by cutting a large opening on the side of the chest where the diseased lung is located. This posterolateral thoracotomy incision extends from below the shoulder blade, around the side of the patient's body, and along the curvature of the ribs at the front of the chest. Sometimes removing part of the fifth rib gives the surgeon a clearer view of the lung and makes it easier to remove the diseased organ.

A surgeon performing a traditional pneumonectomy then:

• deflates (collapses) the diseased lung
• ties off the lung's major blood vessels to prevent bleeding into the chest cavity
• clamps the main bronchus to prevent fluid from entering the air passage
• cuts through the bronchus
• removes the lung
• staples or sutures the end of the bronchus that has been cut
• makes sure that air is not escaping from the bronchus
• inserts a temporary drainage tube between the layers of the pleura (pleural space) to draw air, fluid, and blood from the surgical cavity
• closes the chest incision

Besides removing the diseased lung, a surgeon performing an extrapleural pneumonectomy:

• cuts the pleura away from the chest wall
• removes parts of the pericardium and diaphragm on the affected side of the chest
• substitutes sterile synthetic patches for the tissue that has been removed
• closes the incision