What Is a Pneumonectomy?

In 1895, the first pneumonectomy was performed on a patient with tuberculosis (a disease caused by bacteria) and empyema (collection of pus in the pleural cavity) by surgeon William Macewen. The original treatment procedure involved multiple surgeries over a series of operations. Early attempts often failed until the 1930s, when Rudolf Nissen completed the first successful left-sided pneumonectomy during a two-stage procedure.

Today, pneumonectomies are much safer with modern science. Pneumonectomy candidates often undergo the treatment procedure because a smaller surgery would not be able to remove all of the diseased tissue. Doctors typically try to remove as little of the lung tissue as possible before resulting in the total removal of one lung.

Patients who undergo a pneumonectomy usually suffer from one or more medical issues, including:

  • Bronchial blockage with a destroyed lung
  • Bronchiectasis
  • Congenital lung disease
  • Fungal infections of the lung
  • Pleural Mesothelioma
  • Pulmonary metastases
  • Pulmonary tuberculosis
  • Traumatic lung injury

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Extrapleural Pneumonectomy for Pleural Mesothelioma

Some pleural mesothelioma patients in early stages may undergo an extrapleural pneumonectomy (EPP). The procedure involves the removal of a diseased lung as well as parts of the chest lining, heart lining, diaphragm, and nearby lymph nodes. When combined with other treatment options, such as chemotherapy or radiation, an EPP can increase the patient’s life expectancy by months or possibly years.

For patients whose mesothelioma is confined to the chest cavity, the surgery may help control tumor growth and ease breathing. Most pleural mesothelioma patients receive their diagnosis in later stages and are not eligible for an EPP.

To be eligible for an EPP, mesothelioma patients must be in good overall health with well-functioning lungs and a strong heart. Doctors may use imaging tests to make sure the disease is restricted to one side of the chest to ensure the remaining lung can make up for the loss of the cancerous one.

How The Procedure Works

An extrapleural pneumonectomy is done while the patient is under general anesthesia. Typically, the patient lays on their side on an operating table while receiving antibiotics through an intravenous infusion (IV). Once the anesthesia puts the patient to sleep, the surgeon makes an incision up to 10 inches long.

After the incision is made on the front of the body or on the side, the surgeon will inspect and remove the diseased tissue. The removed tissue typically involves an entire lung after deflating it. An EPP also removes parts of the heart lining (pericardium), the lining of the lung (pleura), diaphragm, or nearby lymph nodes. The procedure takes several hours. Speak with your doctor or cancer care team for more information regarding an EPP.

 

Video Transcript

 

“An extrapleural pneumonectomy-the definition is you take the pleura, which is the lining of the lung, the lung itself, and the diaphragm, the muscle between your chest and belly that helps you breathe, and the pericardium, the covering of the heart, and you remove that, with the tumor in the middle. Theoretically, it makes more sense this would get rid of the tumor, but practically, you don’t see it. Now, you’ve got to realize, you’ve lost that lung, and if you get mesothelioma that returns, which most of the time it will, where’s it going to return? The other chest, or in the abdomen. It’s like you painted yourself into a corner. That’s why the pleurectomy decortication is better, it allows you to keep fighting. The best analogy is like peeling an orange. So you take the orange peel and that’s the tumor and you pull that off, but the orange doesn’t have cancer in it. The lung doesn’t have cancer in it. The cancer is coming around it. So you get rid of that and now the patient has a big expanded lung. Now they can tolerate other treatments better. And when the cancer comes back, whether it’s here or there, they have more of a reserve.” -Dr. Raja Flores

 

Recovering From an Extrapleural Pneumonectomy

When the procedure is finished, the patient may wake up from anesthesia slightly confused. It’s normal to feel out of it after first waking up. The medical team will carefully watch the patient’s heart rate, breathing, blood pressure, and oxygen levels.

Patients can expect to have a small oxygen tube placed in their nose and do breathing therapy to remove fluids that may collect in the remaining lung during surgery. The patient might be sore but shouldn’t expect severe pain.

After several days spent recovering in the hospital, a loved one can drive the patient home, where they may need help getting around for a couple of days. Over the course of a few follow-up appointments, stitches or staples will be removed. Patients can expect a slow start to recovery as it may take several months to fully regain strength.

If you undergo an EPP your healthcare provider will give you information on medicine, exercise, diet, and wound care. Be sure to follow up with them regarding any questions you may have.

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Potential Surgical and Recovery Complications

Potential complications largely depend on the patient’s age at the time of surgery. Possible complications during surgery can range from abnormal heart rate (supraventricular tachycardia) to death.

Possible complications of EPP include:

  • Abnormal heart rhythms
  • Blood clot in the lung (pulmonary embolism)
  • Complications from anesthesia
  • Pneumonia
  • Reduced blood flow to the heart
  • Respiratory failure
  • Shock
  • Too much bleeding

Patients who undergo an EPP must monitor their health following treatment to prevent infection or pneumonia. The mortality rate following an EPP has improved significantly since the 1900s.

Learn More About EPP

Since the procedure is more invasive, an extrapleural pneumonectomy can be intimidating. Speak with your cancer care team to find out if the procedure may improve your quality of life or if you are eligible. To learn more about mesothelioma treatment, download our free mesothelioma guide.

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