70 - Pneumonectomy

Summary

The chief indication for pneumonectomy is a pulmonary neoplasm involving structures that render pulmonary lobectomy unfeasible. On rare occasions, pneumonectomy may be indicated for benign conditions, such as residual problems with pulmonary tuberculosis, lung trauma, or complications of a pulmonary lobectomy.

General endotracheal anesthesia is administered with the aid of an indwelling double-lumen tube to ensure proper inflation of the dependent lung and to protect it from blood or secretions draining down from the operated bronchus. Patients are placed in the lateral decubitus position. The procedure takes 1½ to 2 hours. While blood transfusion is rarely required in elective pneumonectomy, blood should always be available. The main operative steps consist of control of the pulmonary artery and superior and inferior pulmonary veins and secure closure of the bronchial stump. The procedure carries a high level of surgical stress and should only be performed in patients who have been demonstrated to have sufficient pulmonary reserve to tolerate the procedure. Therefore, results of preoperative pulmonary function tests comprise the main patient selection criteria for elective resection. Cardiac status should also be evaluated before operation using an exercise treadmill or thallium scan.

Usual postoperative course

Expected postoperative hospital stay

6 to 7 days.

Operative mortality

5%–12%.

Special monitoring required

Patients remain in the intensive care unit for 1 or 2 days to allow close observation for arrhythmias, pulmonary reserve, urinary output, and other vital functions. To monitor respiratory status, blood gases are assessed daily or, if necessary, more often.