Pneumonectomy - NYSORA

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Pneumonectomy

Learning objectives

  • Describe the indications for and types of pneumonectomy
  • Manage patients presenting for pneumonectomy

Background

  • Pneumonectomy involves the surgical removal of an entire lung
  • Should only be considered if all other options, including sleeve lobectomy and non-anatomical resections, have been deemed inappropriate

Indications

  • Bronchial carcinoma
  • Traumatic injury to the lung with uncontrolled hemorrhage
  • Chronic infective disorders of the lung (e.g., tuberculosis)
  • Fungal infections resulting in lung destruction

Types of pneumonectomy

  • Standard pneumonectomy:  Removal of the affected lung only
  • Intrapericardial pneumonectomy: Longitudinal opening of the pericardium behind the phrenic nerve, indicated for locally advanced bronchogenic carcinoma
  • Extrapleural pneumonectomy: Radical type of resection sometimes used for selected cases of mesothelioma, involves excision of the affected lung, ipsilateral pleura, hemidiaphragm, and hemipericardium, with patch reconstruction
  • Completion pneumonectomy: Excision of the residual lung tissue after resection during previous surgery
  • Carinal pneumonectomy: Excision of the lung and carina in patients with tumors of the distal trachea or carina

Management

pneumonectomy, lung cancer staging, ct, pet-ct, lymph node, mediastinal sampling, endobronchial ultrasound, mediastinoscopy, shuttle walk, cardiopulmonary exercise testing, oxygen, transthoracic echocardiography, pulmonary hypertension, forced expiratory volume diffusing capacity for carbon monoxide, ppo, dyspnea

pneumonectomy, rigid bronchoscopy, sleeve lobectomy, vascular sleeve resection, posterolateral thoracotomy, thoracoscopic, thoracic epidural, paravertebral, vasopressors, volatile, iv, arterial blood pressure, central venous catheterization, urinary catheter, decubitus, thromboembolism, normothermia, collapse, doube-lumen tube, bronchial blocker, fiberoptic bronchoscopy, one-lung ventilation, tidal volume, peak airway pressure, peep, oxygen saturation, hypovolemia, hemorrhage, cardiovascular collapse

pneumonectomy, extubate, thoracic epidural, paravertebral, organ support, vasopressors, monitoring, chest drain, arrhythmia, atrial fibrillation, flutter, supraventricular tachycardia, pulmonary edema, bronchopleural fistula, cardiac herniation, surgery

Suggested reading

  • Beshara M, Bora V. Pneumonectomy. [Updated 2022 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555969/
  • Hackett S, Jones R, Kapila R. Anaesthesia for pneumonectomy. BJA Educ. 2019;19(9):297-304.
  • Lederman D, Easwar J, Feldman J, Shapiro V. Anesthetic considerations for lung resection: preoperative assessment, intraoperative challenges and postoperative analgesia. Ann Transl Med. 2019;7(15):356.

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