A person can live a long and functional life after the removal of an entire lung, a procedure known as a pneumonectomy. This surgery is typically performed to treat advanced lung cancer, extensive trauma, or severe, widespread infection. The body compensates for this substantial loss of respiratory capacity, allowing the remaining lung to take on the function of both. The ultimate quality of life depends heavily on the health of the remaining lung before surgery and the body’s subsequent physiological adaptations.
Physiological Adaptation to Reduced Lung Capacity
The body survives with one lung primarily through a compensatory process called hyperinflation. This involves the over-expansion of existing bronchial structures and alveoli, not the growth of new lung tissue. The remaining lung expands to occupy the vacated space, recruiting previously underused alveoli to increase the surface area for gas exchange.
The circulatory system immediately adapts by rerouting the entire cardiac output to the single lung. This requires the remaining lung to handle all blood flow previously divided between two organs. Although pulmonary artery pressure may increase transiently, it often returns to a near-normal or mildly elevated level at rest.
The body becomes highly efficient at gas exchange in this reduced state, maintaining normal oxygen and carbon dioxide levels during rest. This resting efficiency permits a generally normal daily life, though the reserve capacity needed for physical exertion is significantly diminished.
The Pneumonectomy Procedure and Immediate Recovery
Pneumonectomy involves surgically dividing and sealing the main bronchus, pulmonary artery, and pulmonary veins leading to the affected lung, followed by the complete removal of the organ. Common reasons for this procedure include centrally located lung tumors that cannot be adequately removed by less extensive surgery, or massive, irreparable lung damage from trauma or infection.
In the immediate post-operative period, patients are closely monitored, often in intensive care, focusing on pain management and stabilizing cardiopulmonary function. The space left by the removed lung initially fills with air, which is progressively absorbed and replaced by fluid over the following weeks. This fluid helps stabilize the chest cavity.
A natural adjustment is the slight movement of the mediastinum—the compartment containing the heart and major blood vessels—toward the empty side. This mediastinal shift helps center the heart and allows the remaining lung to expand optimally. To stabilize pressure dynamics, a chest tube with suction is often avoided, allowing the space to fill and stabilize. The typical hospital stay lasts about five to seven days.
Long-Term Functional Capacity and Lifestyle Adjustments
Full adaptation typically takes six to twelve months, after which individuals can resume most activities of daily living with little or no shortness of breath at rest. However, the reduction in total lung capacity results in a permanent limitation on aerobic capacity (\(\text{VO}_2\text{max}\)). Functional capacity tests frequently show a decrease in peak oxygen uptake of 20% to 50% compared to pre-surgery levels.
Moderate physical activity is possible and encouraged, but high-intensity or sustained endurance activities, such as running a marathon, are typically limited. This limitation is often related to the cardiovascular system’s ability to handle the increased blood flow and pressure, rather than the lung’s ability to exchange gas.
Managing respiratory infections is a lifelong consideration, as the body lacks a reserve if the single functional lung is compromised. Annual influenza and pneumococcal vaccines are strongly recommended for all post-pneumonectomy patients to minimize the risk of severe illness. Travel to high altitudes, generally above 2,400 meters (8,000 feet), presents a significant challenge because the lower oxygen concentration can severely stress the reduced lung capacity, potentially requiring supplemental oxygen.