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Pneumonectomy Aftercare
Chest tubes drain fluid from the incision and a respirator helps the patient breathe for at least 24 hours after the operation. The patient may be fed and medicated intravenously. If no complications arise, the patient is transferred from the surgical intensive care unit to a regular hospital room within one to two days.
A patient who has had a conventional pneumonectomy will usually leave the hospital within 10 days. Aftercare during hospitalization is focused on:
• relieving pain
• monitoring the patient’s blood oxygen levels
• encouraging the patient to walk in order to prevent formation of blood clots
• encouraging the patient to cough productively in order to clear accumulated lung secretions
If the patient cannot cough productively, the doctor uses a flexible tube (bronchoscope) to remove the lung secretions and fluids.
Recovery is usually a slow process, with the remaining lung gradually taking on the work of the lung that has been removed. The patient may gradually resume normal non-strenuous activities. A pneumonectomy patient who does not experience postoperative problems may be well enough within eight weeks to return to a job that is not physically demanding; however, 60% of all pneumonectomy patients continue to struggle with shortness of breath six months after having surgery.
Risks of pneumonectomy
The risks for any surgical procedure requiring anesthesia include reactions to the medications and breathing problems. The risks for any surgical procedure include bleeding and infection.
Between 40% and 60% of pneumonectomy patients experience such short-term postoperative difficulties as:
• prolonged need for a mechanical respirator
• abnormal heart rhythm (cardiac arrhythmia); heart attack (myocardial infarction); or other heart problem
• pneumonia
• infection at the site of the incision
• a blood clot in the remaining lung (pulmonary embolism)
• an abnormal connection between the stump of the cut bronchus and the pleural space due to a leak in the stump (bronchopleural fistula)
• accumulation of pus in the pleural space (empyema)
• kidney or other organ failure
Over time, the remaining organs in the patient’s chest may move into the space left by the surgery. This condition is called postpneumonectomy syndrome; the surgeon can correct it by inserting a fluid-filled prosthesis into the space formerly occupied by the diseased lung.
Normal results of pneumonectomy
The doctor will probably advise the patient to refrain from strenuous activities for a few weeks after the operation. The patient’s rib cage will remain sore for some time.
A patient whose lungs have been weakened by noncancerous diseases like emphysema or chronic bronchitis may experience long-term shortness of breath as a result of this surgery. On the other hand, a patient who develops a fever, chest pain, persistent cough, or shortness of breath, or whose incision bleeds or becomes inflamed, should notify his or her doctor immediately.
Morbidity and mortality rates of pneumonectomy
In the United States, the immediate survival rate from surgery for patients who have had the left lung removed is between 96% and 98%. Due to the greater risk of complications involving the stump of the cut bronchus in the right lung, between 88% and 90% of patients survive removal of this organ. Following lung volume reduction surgery, most investigators now report mortality rates of 5–9%.
Alternatives
Lung cancer
The treatment options for lung cancer are surgery, radiation therapy, and chemotherapy, either alone or in combination, depending on the stage of the cancer. After the cancer is found and staged, the cancer care team discusses the treatment options with the patient. In choosing a treatment plan, the most significant factors to consider are the type of lung cancer (small cell or nonsmall cell) and the stage of the cancer. It is very important that the doctor order all the tests needed to determine the stage of the cancer. Other factors to consider include the patient’s overall physical health; the likely side effects of the treatment; and the probability of curing the disease, extending the patient’s life, or relieving his or her symptoms.
Chronic obstructive pulmonary disease
Although surgery is rarely used to treat COPD, it may be considered for people who have severe symptoms that have not improved with medication therapy. A significant number of patients with advanced COPD face a miserable existence and are at high risk of death, despite advances in medical technology.
This group includes patients who remain symptomatic despite the following:
• smoking cessation
• use of inhaled bronchodilators
• treatment with antibiotics for acute bacterial infections, and inhaled or oral corticosteroids
• use of supplemental oxygen with rest or exertion
• pulmonary rehabilitation
After the severity of the patient’s airflow obstruction has been evaluated, and the foregoing interventions implemented, a pulmonary disease specialist should examine him or her, with consideration given to surgical treatment. Surgical options for treating COPD include laser therapy or the following procedures:
• Bullectomy. This procedure removes the part of the lung that has been damaged by the formation of large air-filled sacs called bullae.
• Lung volume reduction surgery. In this procedure, the surgeon removes a portion of one or both lungs, making room for the remaining lung tissue to work more efficiently. Its use is considered experimental, although it has been used in selected patients with severe emphysema.
• Lung transplant. In this procedure a healthy lung from a donor who has recently died is given to a person with COPD.
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