Pneumonectomy

What this procedure is

A pneumonectomy is a type of surgery where a surgeon removes one of your entire lungs. While most people have two lungs that work together to help them breathe, it is possible to live a full life with only one lung. This procedure is usually considered when a smaller surgery, such as removing only a portion of the lung, is not enough to treat the condition.

The surgery is performed in a hospital while you are under general anesthesia, which is a deep sleep that ensures you do not feel pain during the operation. Your clinician may use different techniques depending on your specific needs, but the goal is always to safely remove the affected lung and help you begin the recovery process.

What it treats or fixes

This procedure is most often used to treat certain types of lung cancer. It is typically recommended if a tumor is located in the center of the lung or if the cancer has spread through the major airways or blood vessels of that lung. By removing the entire lung, surgeons aim to remove as much of the cancer as possible.

Beyond cancer, a pneumonectomy may be used to treat other serious conditions, including:

• Severe lung damage: This can be caused by traumatic injuries or long-term infections like tuberculosis.
• Congenital issues: Some people are born with lung problems that may eventually require surgery.
• Rare tumors: Conditions like mesothelioma or certain non-cancerous growths that affect the entire lung.

How common it is & where it's done

A pneumonectomy is a major surgical procedure. While it is less common than surgeries that remove only a small section of the lung (called a lobectomy), it is a standard treatment in many large hospitals. It is performed by thoracic surgeons, who are doctors specially trained in operations involving the chest and lungs.

Before the surgery, your clinician may perform several tests to check your heart health and the strength of your other lung. This helps ensure that your remaining lung can effectively do the work of both lungs after the procedure. These surgeries are typically done in specialized medical centers that have the equipment and staff needed for advanced chest surgery and recovery care.

Recovery: What to Expect

After a pneumonectomy (the removal of one lung), you will likely stay in the hospital for several days. During this time, your care team will focus on managing your comfort and helping you breathe deeply. You will be encouraged to sit up and walk shortly after surgery to help your circulation and keep your remaining lung clear.

Your clinician may ask you to use an incentive spirometer. This is a handheld device that helps you practice taking slow, deep breaths to keep your lung healthy. You will also receive guidance on how to care for your incision (the surgical cut) and how to slowly increase your activity levels once you return home.

Risks & Possible Complications

While many people recover without major issues, all surgeries carry some risks. These may include infection, bleeding, or blood clots. Because the heart and lungs work closely together, some patients may experience an irregular heartbeat (arrhythmia) or fluid buildup in the chest after the procedure.

It is important to watch for signs that you need a check-up. You should contact your clinician if you experience any of the following:

• A fever or chills.
• Increased redness, swelling, or drainage from your incision.
• New or worsening shortness of breath.
• Pain that is not helped by your prescribed medication.

Outcomes & Long-Term Results

Most people are able to live a full life with only one lung. The remaining lung is usually able to provide enough oxygen for your body's daily needs. Over time, the remaining lung may even expand slightly to fill some of the extra space in the chest.

While you may find that you get winded more easily during very heavy exercise, most patients return to their normal daily routines and hobbies. Your clinician may schedule regular follow-up appointments and imaging tests to monitor your health and ensure your remaining lung is functioning well.

Emotional Support & Reassurance

It is normal to feel a range of emotions, including anxiety or fatigue, as you recover from a major surgery. Healing takes time, and your body is working hard to adapt. Focusing on small, daily goals can help you see the progress you are making each week.

Your clinician may recommend pulmonary rehabilitation. This is a specialized program that uses exercise and education to help you build strength and confidence. Connecting with a support group or talking with your healthcare team about your feelings can also provide comfort as you return to your active life.

Why doctors recommend it

A pneumonectomy is a surgery to remove an entire lung. Your clinician may recommend this procedure if a disease or injury is too large to be treated by removing only a small section of the lung. The most common reason for this surgery is lung cancer that is located near the center of the lung or has spread throughout one side.

Other reasons for this recommendation may include:

• Severe lung damage from long-term infections like tuberculosis or certain fungal diseases.
• Traumatic injury, such as a severe chest wound that causes damage that cannot be repaired.
• Congenital conditions, which are health issues present from birth that affect how the lung develops or works.
• Mesothelioma, a type of tumor that affects the lining of the lung and often requires removing the whole lung to clear the diseased tissue.

Urgent vs planned treatment

Most pneumonectomies are planned well in advance. This allows your healthcare team to perform tests to ensure your remaining lung is healthy enough to do the work of both lungs. These tests often include pulmonary function tests, which measure how much air your lungs can hold and how well they move oxygen into your blood.

In rare cases, the surgery may be performed as an urgent or emergency treatment. This typically happens after a sudden, severe injury to the chest. If there is uncontrollable bleeding or major damage to the bronchus (the main airway leading into the lung) that cannot be fixed, a surgeon may need to remove the lung quickly to save the patient's life.

Goals of treatment

The main goal of a pneumonectomy is to remove the source of a serious health problem. For patients with cancer, the goal is to remove the entire tumor and nearby lymph nodes (small structures that filter fluid) to help prevent the cancer from spreading to other parts of the body.

Other goals of this treatment include:

• Stopping chronic infection: Removing a lung that is permanently damaged by infection can prevent the illness from spreading to the healthy lung.
• Managing symptoms: Removing a diseased lung can sometimes help reduce pain or breathing difficulties caused by damaged tissue.
• Controlling bleeding: In cases of severe injury, the goal is to stop life-threatening blood loss that cannot be managed with other treatments.

Success generally means the diseased tissue is gone and the patient can return to daily activities using their remaining lung. Your medical team will work with you to help your body adjust to breathing with one lung after the procedure.

Who may benefit

A pneumonectomy is a surgery to remove one entire lung. This procedure is most often used to treat lung cancer when a tumor is located near the center of the chest or has spread throughout the different sections, or lobes, of a single lung. By removing the whole lung, surgeons aim to remove as much of the cancer as possible to prevent it from returning.

Your clinician may also suggest this surgery for conditions other than cancer. This includes severe lung damage from long-term infections like tuberculosis or certain fungal infections. It may also be used if a person has bronchiectasis (a condition where the airways are permanently widened and scarred) or if there has been a major injury to the lung or its main blood vessels that cannot be repaired.

When it may not be the right option

This surgery is a major procedure, and it may not be the right choice for everyone. Before recommending it, your care team will perform tests to check how well your heart and your other lung are working. If the remaining lung is not strong enough to provide enough oxygen for your body on its own, your clinician may look for other treatment options.

In some cases of lung cancer, if the disease has spread to distant parts of the body, surgery may not be the most effective approach. Additionally, if the problem can be treated by removing only a small piece or one section of the lung (a lobectomy), your surgeon will usually prefer that path to save as much healthy lung tissue as possible. People with very recent heart problems or severe overall health issues may also be advised to avoid this surgery.

Questions to ask your care team

It is helpful to bring a list of questions to your appointments to help you feel more prepared. You may want to ask:

• Why is removing the whole lung necessary instead of removing just a part of it?
• How will my breathing feel after I have fully recovered from the surgery?
• What specific tests will be done to make sure my heart and other lung are healthy enough for this procedure?
• What are the main goals of this surgery for my specific health situation?
• What are the alternative treatments if I decide not to have this surgery?

In the procedure room

When you arrive in the operating room, the surgical team will help you get comfortable on the procedure table. You will typically be asked to lie on your side. This position helps the surgeon reach the chest area more easily. The team will perform a final safety check to confirm all details before the procedure begins.

High-level steps

The surgeon begins by making an incision, which is a surgical cut, on the side of your chest. This is often done between the ribs. In some cases, your clinician may remove a small piece of a rib to get a better view of the lung.

The surgeon then carefully closes off the blood vessels and the bronchus, which is the main tube that carries air to that lung. Once these are secured, the lung is removed. Before finishing, the surgeon checks the area to make sure there are no air or fluid leaks. The incision is then closed with stitches or surgical staples.

Anesthesia and pain control

A pneumonectomy is performed under general anesthesia. This means you will be in a deep sleep and will not feel any pain or remember the surgery. A special breathing tube is used to help you breathe while the surgeon works.

To help with comfort after you wake up, your clinician may use local numbing medicine around the incision. They might also use an epidural, which is a tiny tube placed in your back, to deliver pain relief directly to the nerves during and after the surgery.

Monitoring and safety steps

Your safety is the top priority throughout the procedure. The care team uses specialized monitors to track your heart rate, blood pressure, and oxygen levels every minute. They also monitor the health of your remaining lung to ensure it is working properly while the other is being treated. To prevent infection, you may receive antibiotics through an IV (a small tube in your vein) before the surgery starts.

Immediately after the procedure

After the surgery is finished, you will be moved to a recovery room or an Intensive Care Unit (ICU). You may feel sleepy, thirsty, or have a bit of a sore throat from the breathing tube. It is normal to feel some pressure or soreness in your chest area.

In some cases, a chest tube may be placed to help drain fluid or air from the space where the lung used to be. Your care team will help you start deep breathing exercises right away. These exercises are important to help your remaining lung stay strong and clear.

Typical procedure length

A pneumonectomy usually takes between 1 and 3 hours to complete. The total time you spend in the operating area may be longer to allow for the time needed to safely start the anesthesia and for you to begin waking up after the surgery is done.

Common approaches (open vs minimally invasive)

The most common way to perform a pneumonectomy is through traditional open surgery, known as a thoracotomy. During this procedure, the surgeon makes an incision on the side of the chest, usually between the ribs. This approach gives the surgical team a wide view of the lung and direct access to major blood vessels, which helps them manage the procedure safely.

In some cases, doctors may use a minimally invasive approach called Video-Assisted Thoracoscopic Surgery (VATS). This involves making several small incisions and using a tiny camera to guide the instruments. While VATS is frequently used for removing smaller parts of the lung, it is less common for removing an entire lung. Your surgeon will decide which method is safest based on the size of the tumor and your overall health.

Partial vs total

A standard pneumonectomy is a “total” removal, meaning the entire right or left lung is taken out. This is typically recommended when a tumor is located near the center of the chest or involves major blood vessels, making it impossible to save part of the organ. If the disease is limited to a smaller area, surgeons usually prefer to remove only a section (lobectomy), but a total pneumonectomy is necessary when partial removal would not clear all the cancer or infection.

For certain conditions, such as mesothelioma (cancer of the lung lining), a more extensive procedure called an extrapleural pneumonectomy may be performed. This involves removing the whole lung along with the lining of the chest wall (pleura), parts of the diaphragm, and the covering of the heart (pericardium). This is a complex surgery and is not applicable for most patients.

Revision or repeat procedures

Sometimes, a patient who previously had part of a lung removed may need a second surgery to remove the rest of that lung. This is known as a “completion pneumonectomy.” This might be necessary if cancer returns in the remaining tissue or if a severe infection damages the lung after the first operation.

These revision procedures are often more technically difficult than the original surgery because scar tissue may have formed inside the chest. Your care team will carefully evaluate your heart and lung function before suggesting this option to ensure your body can handle the change.

Tests and imaging that may be done

Before surgery, your healthcare team needs to ensure you are healthy enough for the procedure. A main goal is to confirm that your remaining lung is strong enough to supply your body with oxygen on its own. You will likely undergo a complete physical exam and blood tests.

Your clinician may also order specific tests to check your lung and heart function, including:

• Pulmonary function tests (PFTs): These measure how much air your lungs can hold and how well they move oxygen into your blood.
• Heart evaluation: Since the heart and lungs work closely together, you may have an echocardiogram or stress test to check your heart health.
• Ventilation-perfusion (V/Q) scan: This imaging test looks at the airflow and blood flow within your lungs.

Medication adjustments

It is important to tell your healthcare provider about all the medicines you currently take. This includes prescription drugs, over-the-counter medications, vitamins, and herbal supplements. You should also let your team know if you have any allergies to medicines, latex, tape, or anesthesia.

Your surgeon may ask you to stop taking certain medicines before the procedure, particularly blood thinners (anticoagulants) or aspirin, as these can increase bleeding risk. However, only stop taking medicines if your clinician specifically instructs you to do so.

Day-before and day-of instructions

If you smoke, your care team will strongly advise you to quit as soon as possible before the surgery. Stopping smoking helps improve your lung function and recovery.

You will generally be given specific instructions on when to stop eating and drinking. Often, you will be asked to fast (have no food or drink) after midnight the night before your surgery. On the morning of the procedure, your care team may give you a sedative to help you relax before you go into the operating room.

General surgical risks

As with any major surgery, a pneumonectomy carries certain general risks. Your surgical team takes many steps to lower these risks and keeps a close watch on your vital signs throughout the process. Possible general risks include:

• Reactions to anesthesia: Some patients may have a reaction to the medicines used to put them to sleep.
• Bleeding: Excessive bleeding can occur during or after the operation.
• Infection: Bacteria may cause an infection at the incision site or inside the chest (pneumonia).
• Blood clots: Clots can form in the legs (deep vein thrombosis) and potentially travel to the lungs (pulmonary embolism).

Procedure-specific complications

Because a pneumonectomy involves removing an entire lung and working near the heart, there are specific complications related to this procedure. Your care team is trained to watch for these issues specifically.

• Heart rhythm changes: It is common to experience an irregular heartbeat, such as atrial fibrillation, after lung surgery.
• Fluid buildup: Fluid may collect in the remaining lung (pulmonary edema), which can affect breathing.
• Air leaks: Rarely, the closure on the airway (bronchus) may not heal completely, creating an abnormal connection called a bronchopleural fistula.
• Chest infection: A collection of infected fluid or pus, known as empyema, can develop in the space where the lung used to be.
• Nerve injury: Nerves near the lung can sometimes be affected, leading to temporary or permanent hoarseness or vocal cord paralysis.

How complications are treated

Most complications are treatable, especially when caught early through careful monitoring in the hospital. Your medical team has specific protocols to manage these issues if they arise.

• Medications: Antibiotics are used to treat infections, and specific drugs can help control irregular heartbeats or prevent blood clots.
• Respiratory support: You may receive extra oxygen or breathing treatments to help your remaining lung work efficiently.
• Draining fluid: If fluid or air builds up in the chest, a chest tube may be left in place or inserted to drain it.
• Additional procedures: In rare cases, such as a persistent air leak, a second procedure may be needed to repair the area.

Pain control medicines

Managing pain is a priority after a pneumonectomy (surgery to remove a lung). Your clinician may use a combination of medicines to keep you comfortable. This often includes strong pain relievers called opioids for the first few days. They may also suggest options like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and soreness.

In some cases, your care team might use a nerve block or an epidural. This involves numbing the area around the surgical site with local anesthesia. It is important to tell your clinician about any allergies or if you have had bad reactions to pain medicine in the past. Common side effects can include sleepiness or constipation.

Antibiotics

To help prevent an infection after surgery, your clinician will likely give you antibiotics. These are medicines that kill or stop the growth of bacteria. You will usually receive the first dose through an IV (a small tube in your vein) just before the procedure begins.

Your care team may continue these medicines for a short time after the surgery is finished. Your clinician will tailor this based on your specific needs. Always let your doctor know if you have a known allergy to specific antibiotics, such as penicillin. Taking these as directed helps ensure your recovery stays on track.

Blood thinners and clot prevention

After lung surgery, you may not be moving around as much as usual. This can increase the risk of blood clots forming in the legs. To help prevent this, your clinician may prescribe blood thinners, also known as anticoagulants. These medicines help keep the blood flowing smoothly.

Commonly used blood thinners include heparin or enoxaparin, which are often given as small injections. Your clinician will tailor the type and timing of these medicines based on your health history. While these help prevent clots, they can increase the risk of bruising or bleeding, so your team will monitor you closely.

Emergency warning signs

While recovering from a pneumonectomy, certain symptoms require immediate medical attention. These signs may indicate a blood clot, a heart issue, or severe trouble with your remaining lung. Call 911 or go to the nearest emergency room if you experience:

• Sudden or severe shortness of breath that does not get better with rest.
• Chest pain that is sharp or worsens when you take a deep breath.
• Coughing up bright red blood.
• Signs of a blood clot in the leg, such as sudden swelling, warmth, redness, or tenderness in one calf.
• Confusion, fainting, or a very fast or irregular heartbeat.

Call your surgeon or clinic if…

Some symptoms are not immediate emergencies but still need prompt attention from your surgical team to prevent complications like infection or pneumonia. Contact your healthcare provider if you notice:

• Fever: A temperature higher than 100.4°F (38°C), or chills.
• Incision changes: Redness, swelling, warmth, or foul-smelling drainage coming from your surgical cut.
• Pain issues: Pain that gets worse or is not helped by your prescribed medication.
• Cough changes: A new cough or coughing up yellow or green mucus.

Expected vs concerning symptoms

Recovery takes time, and it can be hard to tell what is a normal part of healing and what is a sign of a problem. Here is a guide to help you distinguish between the two.

• Breathing: It is normal to feel short of breath with activity as your body adjusts to having one lung. It is concerning if you feel short of breath while resting or if your breathing gets harder over time instead of easier.
• Heart rate: Your heart rate may be slightly higher than usual during recovery. It is concerning if you feel your heart fluttering, racing, or skipping beats (arrhythmia), which can happen after this type of surgery.
• Fluid and Air: Your care team expects fluid to fill the space where the lung was removed. However, it is concerning if you cough up large amounts of thin, watery fluid or feel a sudden shift in fluid inside your chest, as this could be a sign of an abnormal air leak (bronchopleural fistula).

Non-surgical treatments

Before suggesting a pneumonectomy (the removal of an entire lung), your clinician may look at other ways to treat the condition. For lung cancer, common options include chemotherapy (using strong medicines to kill cancer cells) or radiation therapy (using high-energy beams to target the tumor). These treatments can sometimes shrink a tumor enough that a smaller surgery, or no surgery at all, is needed.

In some cases, doctors use targeted therapies or immunotherapy. These are newer treatments that help the body's own immune system fight the disease. For infections like tuberculosis or severe fungal issues, your care team will usually try long-term antibiotics or antifungal medications first to see if the lung can heal without being removed.

Watchful waiting

In certain situations, your clinician might suggest "watchful waiting," also called active surveillance. This means they will monitor your condition closely with regular imaging tests, like CT scans or X-rays, instead of starting surgery right away. This is often considered if a growth is very small, slow-moving, or if the risks of a major operation are currently higher than the benefits.

During this time, your medical team looks for any signs of change. If the condition stays the same and does not cause symptoms, surgery may be delayed. This approach helps ensure that major procedures are only done when they are truly necessary for your health and quality of life.

When surgery becomes the best option

A pneumonectomy is usually considered when other treatments have not worked or are not the right fit for the specific type of disease. If a tumor is located in the center of the lung or has spread through all the sections (lobes) of one lung, removing the entire organ may be the most effective way to clear the illness.

Your clinician may decide surgery is the best path if:

• The disease is localized to one lung and can be completely removed.
• Other treatments, like radiation or chemotherapy, have not stopped the growth.
• The lung is so damaged by infection or trauma that it is no longer working and is causing harm to the rest of your body.

Before moving forward, your team will perform pulmonary function tests. These are breathing tests that help confirm your remaining lung is strong enough to support your body on its own. The goal is always to choose the option that provides the best long-term outcome while keeping you as safe as possible.

Hospital services that commonly perform this surgery

A pneumonectomy is a major operation to remove an entire lung. Because it requires specialized care, it is usually performed in large medical centers or dedicated chest (thoracic) surgery departments. These facilities have the equipment and experts needed to monitor your breathing and heart health closely before, during, and after the procedure.

Your care team will likely include thoracic surgeons, who specialize in chest operations, and pulmonologists, who are doctors focused on lung health. You may also spend time in an Intensive Care Unit (ICU) or a specialized surgical recovery floor where nurses are trained to help patients who have had lung surgery.

Patient resources and support services

Many hospitals offer programs to help you prepare for surgery and recover more effectively. One of the most important services is pulmonary rehabilitation. This is a program that uses exercise and breathing techniques to help improve your lung function and physical strength after surgery.

Other helpful resources may include:

• Respiratory Therapy: Specialists who help you use tools like an incentive spirometer (a device to help you take deep breaths) to keep your remaining lung healthy.
• Pain Management Teams: Experts who focus on keeping you comfortable so you can move and breathe deeply during recovery.
• Patient Navigators: Staff members who help coordinate your appointments and guide you through the healthcare system.
• Nutrition Services: Dietitians who can help you eat the right foods to support your body while it heals.

Questions for choosing where to have surgery

Choosing the right facility is an important step in your treatment journey. Your clinician may suggest a specific hospital based on your needs, but you can also ask questions to feel more confident in your choice.

Consider using this checklist when looking at a hospital or surgical center:

• How many pneumonectomy procedures does this surgical team perform each year?
• Does the hospital have a dedicated team of specialists, such as thoracic surgeons and specialized nurses, who work together on my care?
• Is there an Intensive Care Unit (ICU) on-site with experience caring for lung surgery patients?
• What kind of support services, like physical therapy or pulmonary rehab, are available during my hospital stay and after I go home?
• Does the facility offer resources to help my family or caregivers understand the recovery process?

Conditions commonly treated by this procedure

A pneumonectomy is a major surgery where a surgeon removes an entire lung. This procedure is most often used to treat certain types of lung cancer when the tumor is located in the center of the lung or has spread throughout that side. It may also be used for mesothelioma, which is a type of cancer that affects the lining around the lungs.

In some cases, your clinician may recommend this surgery for non-cancerous conditions. These can include:

• Severe lung infections: Chronic infections like tuberculosis or certain fungal infections that do not get better with medicine.
• Traumatic injury: Serious damage to the lung or its main blood vessels caused by an accident or injury.
• Bronchiectasis: A condition where the airways in the lung become permanently widened and damaged, leading to frequent infections.
• Congenital issues: Lung problems that a person is born with that may require removal later in life to prevent complications.

Related symptoms people search for

People who are candidates for this surgery often experience symptoms related to their underlying lung condition. While these symptoms do not always mean surgery is needed, they are often the reason a person seeks medical evaluation. Common symptoms can include:

• Shortness of breath: Feeling like you cannot get enough air, especially during physical activity.
• Persistent cough: A cough that does not go away or changes over time.
• Chest pain: Discomfort or pressure in the chest area that may get worse with deep breathing.
• Coughing up blood: Seeing blood in the mucus when you cough, which should always be checked by a clinician.

Other signs may include feeling very tired or losing weight without trying. Because these symptoms can be associated with many different health issues, it is important to have a thorough evaluation by your healthcare team to determine the cause and the best treatment plan for you.

Evidence overview

Pneumonectomy is a well-established surgical procedure that involves removing an entire lung. Medical experts generally consider this surgery when less invasive options, such as removing only a small section or a single lobe of the lung, cannot safely remove all the disease. It is most often used to treat lung cancer, but it is also a proven treatment for severe chest injuries or chronic infections like tuberculosis.

Because living with one lung is a significant change for the body, doctors follow strict medical guidelines to decide if this surgery is the right choice. Evidence shows that for this surgery to be successful, the patient must have enough strength in their heart and remaining lung to handle the procedure and recovery.

Safety notes and individualized care

Since removing a lung is a major operation, your healthcare team will take specific steps to manage your safety. Before surgery, you will undergo a thorough evaluation. This typically includes heart checks and breathing tests (pulmonary function tests) to confirm that your remaining lung is healthy enough to do the work for both lungs.

While the procedure is standard for treating serious lung conditions, it does carry risks. Your clinician will discuss potential complications with you, which may include:

• Infection or bleeding at the surgical site.
• Changes in heart rhythm (arrhythmia).
• Pneumonia or fluid buildup in the chest.
• Air leaking from the remaining lung tissue.

Recovery is different for every person. You will likely stay in the hospital for several days, often starting in an intensive care unit (ICU) where nurses can monitor your breathing and heart rate closely. Your recovery plan will usually include pain management and respiratory therapy to help keep your remaining lung clear and strong.