A B C D E F G H I J K L M N O P R S T U V W

PNEUMONECTOMY / LOBECTOMY

Why is a Pneumonectomy performed ?

Removal of all or part of the lung is most commonly performed because of the presence of a tumour. This may be malignant or benign. Less often, patients with serious lung infections may require such an operation.

Preparations needed for a Pneumonectomy

It is vital that you give up smoking completely. Failure to do this could result in pneumonia after the operation. The patient will be admitted several days before surgery. Tests will help to discover whether a tumour can be adequately treated by an operation, and will also assess the patient's fitness. The physiotherapist will help you to get your lungs into condition with breathing exercises. She will prepare you for the deep breathing and coughing which must continue after the operation. You can expect to remain in hospital for 10 to 14 days after surgery. Your employers should be warned that you will be off work for about 3 months.

What Happens during a Pneumonectomy

An hour before operation, you will be given an injection, or 'pre-medication'. This will make you drowsy and cause a dry mouth. In the operating theatre you will be put to sleep completely. The cut is in the side of the chest. Once the lung is exposed, the problem is further assessed. A final decision can then be made as to the extent of operation required. Ideally, as little lung as possible should be removed. Frequently, however, to completely clear a tumour, the whole lung must be taken out, rather than its separate parts (or lobes). Firstly, the blood vessels of the lobe or lung are cut and tied off. Next the bronchus (windpipe) of the lobe/lung is also cut and the stump left behind is closed. In a pneumonectomy, the lung can now be removed. In a lobectomy, frequently some attachment to the other lobes is found. Should this be the case, the lobes must be separated before the diseased one can be finally taken out. In so doing, a raw surface will be left behind and air will leak out of dozens of tiny holes.

Possible Complications during a Pneumonectomy

Immobility around the time of surgery may result in blood clots forming in the legs. These could break free and travel up into the lungs and may then cause breathing problems and excessively low blood pressure. To try and prevent this problem, you might be given special stockings. You will also be encouraged to move your legs soon after surgery. Another complication which can occur with any operation is that the wound may become infected. Infection in remaining lung tissue is common, partly because patients undergoing lobe or lung removal have usually been smokers. This will have damaged their lungs and made them more likely to get infection. Also, after an operation on the chest, you will naturally be reluctant to breathe deeply and cough. Sputum is not cleared adequately and this can cause infection. If a lobectomy has been performed and a raw area of lung left behind, air may continue to leak for a number of days. Almost always this will get better by itself, but in the meantime the air must be removed through a tube in the side of the chest. Following pneumonectomy, the stump of the windpipe may not heal adequately. A small hole can then appear in the stump. Fluid which has accumulated in the previously empty chest cavity (after removal of the lung) will be coughed up. The surgeon may advise a second operation to close the hole. Alternatively, a tube will be placed through the side of the chest and left to drain off any more fluid.

After a Pneumonectomy

Chest wounds can be quite uncomfortable but treatment will be given to control pain. For the first 24 hours or so, it would be usual to have a drip in an arm, and a mask delivering oxygen over the face. Following pneumonectomy, there will be a tube (drain) in the side of your chest. This allows blood that gathers inside the chest after the operation to be drained away. Such bleeding usually stops after 12 to 18 hours and then the drain is removed. After lobectomy there are two drains. One is for the removal of blood and can be taken out the day after operation. The second drains the air that can leak from the raw lung surface left behind. The air leak may take several days to stop, and then the remaining drain is also removed. The day after surgery, the physiotherapist will begin encouraging you to move your legs and sit out of bed, and to breathe deeply and cough. Patients are normally allowed home about 10 to 14 days after the operation. Depending on what was found by the pathologist, additional radiotherapy may be arranged. Activity will increase over the 3 months of convalescence. After a month, the patient should be walking about a mile per day. Driving should be possible after 6 weeks. Strenuous exercise must be avoided for the full 3 months. After that period there need be no restrictions. A few patients, however, are aware of some deterioration in their breathing, and others have persisting wound discomfort.

If a Pneumonectomy is not performed

If an operation is recommended for a malignant tumour, it is because the doctor believes it will give the best chance of cure. Should an operation be declined, radiotherapy or drugs may be offered as alternatives. Many benign tumours are removed only because a firm diagnosis could not previously be reached. There is concern that they may be malignant. Sometimes, however, benign tumours do themselves cause trouble, e.g. by blocking a windpipe. If left untreated, damage to the lung would occur.