A pneumonectomy is a surgery to remove an entire lung. It’s one of the most extensive operations in thoracic surgery, typically reserved for cases where a tumor or disease is too large or too centrally located for a smaller resection to work. Most people who undergo this procedure are dealing with lung cancer, though it’s also performed for certain rare cancers and, historically, severe infections like tuberculosis.
Types of Pneumonectomy
There are two main types. A simple (or standard) pneumonectomy removes just the lung itself, along with sometimes nearby nerves and tissue. This is the more common version, used primarily for lung cancer that has grown too close to the center of the chest for a partial removal.
An extrapleural pneumonectomy is far more extensive. In addition to the lung, the surgeon removes the pleura (the membrane lining the lung and chest wall), the pericardium (the sac surrounding the heart), and parts of the diaphragm. This version is mainly used for malignant pleural mesothelioma, a cancer that grows along the lung lining. It leaves fewer residual tumor cells than less radical alternatives, but it comes with significantly higher risks of complications and a greater impact on quality of life.
Why It’s Done
The most common reason is non-small cell lung cancer, particularly when the tumor sits near the main airway or major blood vessels where a lobectomy (removing just one lobe) wouldn’t achieve clear margins. Pneumonectomy is essentially the last resort when smaller resections can’t get the job done.
Beyond standard lung cancer, extrapleural pneumonectomy is used for pleural malignancies including mesothelioma, certain thymomas, and low-grade sarcomas that have spread along the pleural surface. These decisions are always made by a multidisciplinary team at specialized centers, because the surgery carries real consequences and isn’t appropriate for every patient.
Who Qualifies for the Surgery
Not everyone with a large lung tumor can safely lose an entire lung. Surgeons rely on pulmonary function testing to determine whether the remaining lung can sustain adequate breathing on its own. British Thoracic Society guidelines set the bar at a pre-operative FEV1 (a measure of how much air you can forcefully exhale in one second) of at least 2 liters for pneumonectomy candidates. For context, a healthy adult might blow 3 to 4 liters.
Doctors also calculate what your predicted post-operative lung function would be. If those values fall above 60% of normal, the surgery is considered low risk. Between 30% and 60%, additional testing is needed. Below 30%, the risk is high enough that exercise stress testing is required before anyone proceeds. Heart function gets scrutinized too, since the remaining lung will need to handle the full blood supply from the heart.
What Happens Inside Your Body Afterward
Losing a lung forces your cardiovascular system to adapt in significant ways. All of the blood that once flowed through two lungs now passes through one. The remaining lung’s blood vessels can’t fully stretch to accommodate the increased flow, so pressure in those vessels rises, even at rest. A study using echocardiography found that pulmonary artery pressure increased significantly within six months of surgery. Patients who had a pneumonectomy averaged pressures around 40 mmHg, compared to about 33 mmHg in patients who had only a lobe removed.
Right pneumonectomy hits harder than left. Because the right lung is larger and handles about 55% of total blood flow, removing it forces a bigger adjustment. Pulmonary artery pressures after right pneumonectomy averaged 48 mmHg versus 35 mmHg after left pneumonectomy. About 60% of pneumonectomy patients showed some degree of right heart chamber enlargement at six months, compared to roughly 24% of those who had smaller resections. This is the heart’s right side working harder to pump against higher resistance.
Possible Complications
The surgery carries a meaningful complication rate. One of the most serious is a bronchopleural fistula, an abnormal opening between the airway stump and the chest cavity. This typically appears within the first two weeks after surgery. Warning signs include sudden shortness of breath, a drop in blood pressure, air leaking under the skin (which feels like crackling when you press on it), and coughing up fluid. When a chest tube is still in place, a large or new air leak through the drainage system may be the only clue. This complication requires urgent treatment.
Post-pneumonectomy syndrome is a later complication, more common after right-sided surgery. Once the lung is gone, the organs in the center of the chest gradually shift toward the empty space. This rotation can compress the remaining lung’s main airway against the spine or aorta, causing progressive difficulty breathing. The remaining lung may herniate into the empty side and overinflate, worsening the obstruction.
Survival Rates for Lung Cancer
For stage III non-small cell lung cancer, which represents many of the cases where pneumonectomy is necessary, overall five-year survival sits around 38%. But outcomes vary considerably based on the specifics. Patients who received chemotherapy after surgery (adjuvant therapy) had a five-year survival of 60%, a notable improvement over the 30% seen in patients who had surgery alone.
The side of surgery matters here too. Five-year survival after left pneumonectomy was 45%, compared to 29% after right pneumonectomy. This difference likely reflects the greater physiological toll of losing the larger right lung, combined with higher complication rates on that side.
Long-Term Exercise and Daily Function
Living with one lung changes your physical capacity, but perhaps less dramatically than you might expect for everyday activities. Research on long-term pneumonectomy survivors found that peak exercise capacity dropped substantially, to roughly 48% of what’s predicted for a healthy person of the same age and size. Lung function tests told a similar story: forced vital capacity fell to about 55% of predicted, and FEV1 to about 46%.
Yet functional capacity, the kind of effort needed for real-world tasks like walking, shopping, or climbing stairs, was surprisingly well-preserved. Patients averaged about 490 meters on the six-minute walk test, which is roughly 89% of predicted normal. The main limitation during intense exercise was cardiovascular rather than respiratory. The heart, working against elevated pulmonary pressures with a smaller vascular bed, became the bottleneck before the remaining lung ran out of gas.
In practical terms, this means most long-term survivors can handle daily routines reasonably well but notice real limits during vigorous activity. Pulmonary rehabilitation, which combines guided exercise with breathing techniques, plays a significant role in helping patients reach their functional ceiling after surgery.