Pneumonectomy

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Pneumonectomy
Lung cancer.jpg
Appearance of the cut surface of a pneumonectomy specimen containing lung cancer, here a squamous cell carcinoma (the whitish tumor near the bronchi).
ICD-9-CM32.5
MeSHD011013

A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung first successfully done in 1933 by Dr. Evarts Graham. This is not to be confused with a lobectomy or segmentectomy, which only removes one part of the lung.

There are two types of pneumonectomy, simple and extra pleural. A simple pneumonectomy removes just the lung. An extra pleural pneumonectomy take away part of the diaphragm, the parietal pleura, and the pericardium on that side as well.[1]

Indications[edit]

The most common reason for a pneumonectomy is to remove tumourous tissue arising from lung cancer. Other reasons can arise are a traumatic lung injury, bronchiectasis, tuberculosis, a congenital defect, and fungal infections.[2]

Contraindications[edit]

Tests[edit]

The operation will reduce the respiratory capacity of the patient and before conducting a pneumonectomy, survivability after the removal has to be assessed. If at all possible, a pulmonary function test (PFT) should be done prior. It has been found that forced expiratory volume in one second (FEV1) and diffusion capacity of the lungs (DLCO) provides the best indicator of survival.[3] Other tools can be used to assess effectiveness as well such as cardiopulmonary exercise testing to measure maximal oxygen consumption (Vo(2) max), stair climbing, shuttle walk test, and a 6-min walk test[4]

Pathologies[edit]

If someone has severe valvular disease, severe pulmonary hypertension, or poor ventricular function or if cancer has spread from the lungs into the other intra-abdominal structures, ribs, or contralateral hemithorax, it is contraindicated.[5]

Surgical Approach[edit]

Posterolateral thoracotomy using the fourth or fifth intercostal space is the most common approach used for pneumonectomy. In case of inflammatory and infectious indications, excision of the fifth rib may be necessary to achieve adequate surgical exposure if there is rib crowding.[6]

Video-assisted thoracoscopic surgery (VATS) approach: VATS pneumonectomy is a safe and feasible treatment for advanced malignant and benign diseases and has lower morbidity.[7]

Robotic pneumonectomy for lung cancer is a safe procedure and a reasonable alternative to thoracotomy. With a sound technique most procedures can be completed robotically without any major complications.[8]

Anatomical Changes[edit]

After a pneumonectomy is performed changes in the thoracic cavity occur to compensate for the altered anatomy. The remaining lung hyperinflates as well as shifting over along with the heart towards the now empty space. This space is full of air initially after surgery, but then it is absorbed and fluid eventually takes its place.[9]

X-ray of a person who has had their right lung removed. Note how fluid has replaced the lung

History[edit]

Diagram showing the parts removed in a pneumonectomy

Pioneering dates[edit]

  • 1895: first pneumonectomy in multiple stages by William Macewen on a patient with tuberculosis and emphysema
  • 1912: first anatomical dissection lobectomy by Hugh Morriston Davies[10]
  • 1918: first successful lobectomy, by Harold Brunn[11]
  • 1931: first successful pneumonectomy in two stages by Rudolph Nissen on a patient with crush injury to the thorax
  • 1933: first successful single-stage total pneumonectomy by Graham and Singer[12]
  • 1939: first segmentectomy, by Churchill and Belsey[13]

Is it possible to live with one Lung after a Pneumonectomy?[edit]

Living a one-lunged life may sound scary but it is totally compatible with life. Although it is not possible for the lung to re-grow like the liver but the body does compensate by slow and gradual expansion of the other remaining lung towards the void. Post pneumonectomy patients in due time reach about 70-80 percent of their pre surgery lung function.[14] The heart also drifts towards the post pneumonectomy space. A fluid fills the residual space in the chest cavity which slowly gelatinizes into a proteinaceous material and the chest scaffold collapses slightly. This is how nature helps to obliterate the “empty space” left behind by removal of a lung. People have gone back to living near normal life including running marathons after a pneumonectomy provided adequate cardio-pulmonary conditioning has happened.[15]

Complications[edit]

Most common complications after a pneumonectomy are:

See also[edit]

References[edit]

  1. ^ Opitz I, Weder W (June 2017). "A nuanced view of extrapleural pneumonectomy for malignant pleural mesothelioma". Annals of Translational Medicine. 5 (11): 237. doi:10.21037/atm.2017.03.88. PMC 5497104. PMID 28706905.
  2. ^ "Pneumonectomy". www.hopkinsmedicine.org. 2019-11-19. Retrieved 2022-11-09.
  3. ^ Brunelli, Alessandro; Kim, Anthony W.; Berger, Kenneth I.; Addrizzo-Harris, Doreen J. (May 2013). "Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines". Chest. 143 (5 Suppl): e166S–e190S. doi:10.1378/chest.12-2395. PMID 23649437.
  4. ^ Colice, Gene L.; Shafazand, Shirin; Griffin, John P.; Keenan, Robert; Bolliger, Chris T.; American College of Chest Physicians (September 2007). "Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition)". Chest. 132 (3 Suppl): 161S–77S. doi:10.1378/chest.07-1359. PMID 17873167.
  5. ^ Fleisher, Lee A.; Beckman, Joshua A.; Brown, Kenneth A.; Calkins, Hugh; Chaikof, Elliot L.; Chaikof, Elliott; Fleischmann, Kirsten E.; Freeman, William K.; Froehlich, James B.; Kasper, Edward K.; Kersten, Judy R.; Riegel, Barbara; Robb, John F.; Smith, Sidney C.; Jacobs, Alice K. (2007-10-23). "ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery". Journal of the American College of Cardiology. 50 (17): 1707–1732. doi:10.1016/j.jacc.2007.09.001. PMID 17950159. S2CID 37626938.
  6. ^ Bancewicz, J (May 2002). "Mastery of surgery. 4th ed. R. J. Baker and J. E. Fischer (eds) 285 × 215 mm. Pp. 2448. Illustrated. 2001. Philadelphia, Pennsylvania: Lippincott Williams and Wilkins. US$359·00". British Journal of Surgery. 89 (5): 630–630. doi:10.1046/j.1365-2168.2002.02093_2.x. ISSN 0007-1323.
  7. ^ Xu, Hao; Zhang, Linyou (March 2019). "The Feasibility of Thoracoscopic Left Pneumonectomy". The Thoracic and Cardiovascular Surgeon. 67 (2): 137–141. doi:10.1055/s-0038-1642618. ISSN 1439-1902. PMID 29715708.
  8. ^ Patton, Byron D.; Zarif, Daniel; Bahroloomi, Donna M.; Sarmiento, Iam C.; Lee, Paul C.; Lazzaro, Richard S. (2021). "Robotic Pneumonectomy for Lung Cancer: Perioperative Outcomes and Factors Leading to Conversion to Thoracotomy". Innovations (Philadelphia, Pa.). 16 (2): 136–141. doi:10.1177/1556984520978227. ISSN 1559-0879. PMID 33448886.
  9. ^ Beshara, Michael; Bora, Vaibhav (2022). "Pneumonectomy". StatPearls. PMID 32310429. NBK555969.
  10. ^ Naef, A (1993). "Hugh Morriston Davies: First Dissection Lobectomy in 1912". Annals of Thoracic Surgery. 56 (4): 988–989. doi:10.1016/0003-4975(93)90377-t. PMID 8215687.
  11. ^ Wilkins, Earle W. (2013). "Invited Commentary". In Rosenthal, Ronnie Ann; Zenilman, Michael E.; Katlic, Mark R. (eds.). Principles and Practice of Geriatric Surgery. Springer Science & Business Media. pp. 393–395. ISBN 978-1-4757-3432-4.
  12. ^ Horn, L; Johnson DH (July 2008). "Evarts A. Graham and the first pneumonectomy for lung cancer". Journal of Clinical Oncology. 26 (19): 3268–3275. doi:10.1200/JCO.2008.16.8260. PMID 18591561.
  13. ^ Churchill, E; Belsey R (1939). "Segmental Pneumonectomy in Bronchiectasis: The Lingula Segment of the Left Upper Lobe". Annals of Surgery. 109 (4): 481–499. doi:10.1097/00000658-193904000-00001. PMC 1391296. PMID 17857340.
  14. ^ Brunelli, A.; Charloux, A.; Bolliger, C. T.; Rocco, G.; Sculier, J-P.; Varela, G.; Licker, M.; Ferguson, M. K.; Faivre-Finn, C.; Huber, R. M.; Clini, E. M.; Win, T.; De Ruysscher, D.; Goldman, L.; on behalf of the European Respiratory Society and European Society of Thoracic Surgeons joint task force on fitness for radical therapy (2009-07-01). "ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy)". European Respiratory Journal. 34 (1): 17–41. doi:10.1183/09031936.00184308. ISSN 0903-1936.
  15. ^ Ali, Kamran (2023-01-03). "Can you live with one Lung?". Dr Kamran Ali. Retrieved 2023-01-23.
  16. ^ Keshava, Hari B.; Boffa, Daniel J. (November 2015). "Cardiovascular Complications Following Thoracic Surgery". Thoracic Surgery Clinics. 25 (4): 371–392. doi:10.1016/j.thorsurg.2015.07.001. ISSN 1558-5069. PMID 26515939.
  17. ^ Yano, Tokujiro; Kawashima, Osamu; Takeo, Sadanori; Adachi, Hirofumi; Tagawa, Tsutomu; Fukuyama, Seiichi; Shimokawa, Mototsugu; National Hospital Organization Network Collaborative Research-Thoracic Oncology Group (2017). "A Prospective Observational Study of Pulmonary Resection for Non-small Cell Lung Cancer in Patients Older Than 75 Years". Seminars in Thoracic and Cardiovascular Surgery. 29 (4): 540–547. doi:10.1053/j.semtcvs.2017.05.004. ISSN 1532-9488. PMID 29698655.
  18. ^ Darling, Gail E.; Abdurahman, Adel; Yi, Qi-Long; Johnston, Michael; Waddell, Thomas K.; Pierre, Andrew; Keshavjee, Shaf; Ginsberg, Robert (February 2005). "Risk of a right pneumonectomy: role of bronchopleural fistula". The Annals of Thoracic Surgery. 79 (2): 433–437. doi:10.1016/j.athoracsur.2004.07.009. ISSN 1552-6259. PMID 15680809.
  19. ^ Cook, D.; Powell, E.; Gao-Smith, F. (2009). Vincent, Jean-Louis (ed.). "Post-pneumonectomy Pulmonary Edema". Intensive Care Medicine. New York, NY: Springer: 473–482. doi:10.1007/978-0-387-92278-2_45. ISBN 978-0-387-92278-2.
  20. ^ Chambers, N.; Walton, S.; Pearce, A. (June 2005). "Cardiac herniation following pneumonectomy--an old complication revisited". Anaesthesia and Intensive Care. 33 (3): 403–409. doi:10.1177/0310057X0503300319. ISSN 0310-057X. PMID 15973927.

External links[edit]