pneumonectomy

Pneumonectomy is a surgical procedure in which an entire lung is removed. It is reserved for situations in which lung-sparing operations are not feasible or unlikely to achieve cure. The operation is most commonly performed for malignant disease but may be considered for certain severe infections or destroyed lungs that cannot be rehabilitated.

Indications include non-small cell lung cancer with tumors not amenable to lobectomy, centrally located tumors invading the main bronchus or pulmonary vessels, and selected cases of extensive infection or destruction such as bronchiectasis or tuberculosis sequelae. Contraindications include markedly reduced fitness for anesthesia or insufficient function of the remaining lung.

The operation is usually performed through an open thoracotomy, typically a posterolateral incision. The principal vessels and the main bronchus are divided and sealed with stapling devices or sutures, and the lung is removed. Lymph node sampling or dissection is commonly performed when cancer is present. In some centers, VATS pneumonectomy has been reported but remains uncommon due to technical challenges. A chest tube is placed to drain air and fluid postoperatively.

Postoperative care emphasizes pain control, pulmonary rehabilitation, and prevention of complications. Remaining lung function is a key determinant of outcome; many patients experience reduced oxygenation and reduced exercise tolerance, but can recover function in the long term. Mortality in experienced centers is typically in the low single digits; common complications include bronchopleural fistula, empyema, pneumonia, respiratory failure, arrhythmias, and wound infection. Long-term, mediastinal shift can cause post-pneumonectomy syndrome, leading to airway obstruction and dyspnea in rare cases.