A pneumonectomy is a surgical procedure that removes an entire lung from the chest cavity. It is an invasive and radical surgery that is more complicated than removing only the diseased tissue from a lung. It is less radical than an extrapleural pneumonectomy, which involves moving a lung as well as the pleura, lymph nodes, and diaphragm. The procedure may be used to treat a number of serious conditions, including mesothelioma.
Candidates for a Pneumonectomy
Because the procedure is so risky and invasive, not all patients living with mesothelioma or lung cancer are good candidates. If cancer has spread beyond the lung, for instance, the potential benefits are likely not worth the risks of complications of the surgery. The surgery is only performed when there is a chance that it could be curative or lead to remission. If cancer has already spread, removing the lung will not help.
A good candidate for the procedure must also be in good health aside from the underlying condition prompting the surgery. Having other illnesses can significantly increase the risk of complications, including death. One study, for instance, found that a high risk of mortality after a pneumonectomy was strongly associated with coronary artery disease.
During the procedure, the surgeon makes an incision and exposes the space between the lung and the chest wall. Next, they separate the tumor from the chest wall and then resect the lung, pleura, pericardium and diaphragm en bloc (in one piece) dividing the arteries, veins, and bronchi that connect the lung to the heart. Lymph node dissection and reconstruction of the diaphragm and pericardium (membrane surrounding the heart) is then performed.
A thoracotomy is performed if the disease is contained in the chest cavity. The incision is started midway between the top of the shoulder blade and the spine and extends along the sixth rib. The large muscles along the side of the torso - serratus anterior and latissimus dorsi - are both divided. The sixth rib is removed.
The diaphragm and pericardium are reconstructed with synthetic mesh material such as Gore-Tex. The mesh is formed to the chest wall with a fold in it to create a loose area at the center to reduce tension along the suture line and the chance of herniation. The mesh is sutured to the chest wall with nine sutures placed through the patch and between the ribs.
After the pericardial and diaphragmatic reconstruction is completed, an omental (fatty covering over the bowel) flap is sutured to the bronchial stump to cover and protect the area. Alternatively, an intercostal muscle or fat from around the heart may be used. The thoracotomy is closed and the rubber tube is placed into the pneumonectomy space and brought out of the incision.
Recovery after the Pneumonectomy
Recovery from such an invasive and radical surgery is long and progress may be slow. It may take as much as two months or more for a patient to recover fully, and even then the patient may not experience the full recovery. Patients may always live with some impaired lung function or the repercussions of other complications.