Pneumonectomy is a surgical procedure during which one whole lung (right or left) is removed. Although it is quite possible for a person to live with one healthy lung, this procedure is often joined with many preoperative obstacles and intraoperative and postoperative complications. Here we discuss the most common indications for pneumonectomy, possible complications, as well as postoperative quality of life of patients who underwent pneumonectomy.
Indications for Pneumonectomy
If lung tissue removal is needed, it is better to perform a lobectomy (removal of only one lobe) whenever possible, but in some cases a pathological process affects the whole lung and pneumonectomy becomes the only option.
The most common cause for pneumonectomy is lung cancer that affects all the lobes in one lung. Along with the affected lung, its surrounding lymph nodes are also removed to avoid malignant cells spreading through the lymphatic system. Sometimes, a lobectomy is performed first in order to remove the diseased lobe, but if the process spreads to the whole lung over time, a new surgical procedure called a completion pneumonectomy is needed.
Tuberculosis and some other infectious diseases used to be a very common reason for pneumectomy, as they could not be properly managed with medications. Since the arrival of antibiotics, pneumonectomies are performed rarely in these cases. Sarcoidosis affects multiple organs including the lungs, where it forms nodes and granulomas. It is rarely so severe that it requires a pneumonectomy.
Other causes include emergency situations that occur due to accidents, thrombosis, embolism, and others. Some of them are: infarction of the lung, hematothorax (blood in the chest cavity), mechanical destruction of the lung tissue, and bronchial stenosis.
When planning a pneumonectomy, it is important to take into account many factors that could cause pre- and postoperative complications. A pulmonary function test is very important for the prediction of pulmonary function after the dissection.
If lung capacities and volumes are too low, performing a pneumonectomy is not recommended as it will reduce pulmonary function even more. Measures of gas exchange show the efficacy of the respiratory system to provide enough oxygen and expel carbon-dioxide from the organism. These measures should also have certain values in order to consider pneumonectomy.
Possible Complications and Quality of Life
Anatomic changes of the chest cavity are expected after a pneumonectomy and they include air resorption from the chest cavity, filling the empty space with fluid, and organ shifts to the empty side of the chest. The greatest concern during the early postoperative period is hemorrhage, in which case emergency surgery is needed. Due to organ shifting, some of the airways can be twisted, thus obstructing airflow.
Providing the remaining lung is completely healthy, the patient can have a normal life, with the exception of intense physical activity. However, if respiratory function is decreased by any pathological process, the level of disability will be proportional to lung capacity reduction.
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