A pneumonectomy is the surgical removal of an entire lung. It’s one of the most extensive operations in thoracic surgery, reserved for situations where a smaller procedure can’t adequately treat the disease. Most commonly, it’s performed for lung cancer that is too large or too centrally located to be removed by taking out just one lobe of the lung.
Why a Pneumonectomy Is Performed
The most frequent reason for a pneumonectomy is non-small cell lung cancer, particularly tumors that sit near the center of the lung where the major airways and blood vessels converge. When cancer involves this central area (called the hilum), removing just one section of the lung won’t clear the disease. Surgeons only recommend removing the whole lung when a less radical operation isn’t an option.
Beyond lung cancer, a pneumonectomy may be needed for chronic infections that have destroyed the lung tissue beyond repair. Tuberculosis, severe bronchiectasis (a condition where the airways become permanently widened and damaged), and fungal infections can all cause enough destruction to warrant removal. Less commonly, the surgery is performed for traumatic lung injuries, congenital lung abnormalities, or malignant pleural mesothelioma, a cancer of the lung’s outer lining often linked to asbestos exposure.
Types of Pneumonectomy
A standard (or “simple”) pneumonectomy removes the entire diseased lung and nothing else. This is the most common version of the operation.
An extrapleural pneumonectomy is a far more radical procedure. The surgeon removes not only the lung but also the membrane lining the chest cavity, the membrane covering the heart, and part of the diaphragm. This operation is typically reserved for mesothelioma, where cancer has spread beyond the lung itself into surrounding tissues. It is not considered standard for primary lung cancer.
A completion pneumonectomy refers to removing the remainder of a lung when one or more lobes have already been taken out in a previous surgery. This tends to carry higher risk because the surgeon is operating in a chest that has already scarred from the first procedure.
How Surgeons Decide You’re a Candidate
Living with one lung is possible, but only if the remaining lung works well enough to keep you adequately oxygenated. Before surgery, your medical team will run detailed breathing tests to predict how your lungs will function afterward. The two key measurements are how much air you can forcefully exhale in one second and how efficiently your lungs transfer oxygen into your blood.
If the predicted post-operative values for both tests are at or above 60% of normal, you’re generally considered a good surgical candidate. Values between 30% and 60% require additional testing and careful evaluation. Below 30%, the risk of the surgery itself becomes very high, and alternative treatments are usually explored.
What Happens During Surgery
The most common approach is a posterolateral thoracotomy, a long incision along the side and back of the chest between the ribs. Less frequently, surgeons may operate through the breastbone or use smaller incisions with a camera (thoracoscopic approach). You’re placed under general anesthesia, and a special breathing tube ventilates only the healthy lung while the surgeon works on the other side.
After the lung is detached from its blood supply and airway, the remaining bronchial stump (the sealed end of the airway) needs careful attention. On the right side, this stump sits in a more exposed position, making it more vulnerable to developing a leak. Surgeons often reinforce it by wrapping it with a flap of muscle or other tissue. On the left side, the stump naturally tucks beneath the aorta, offering some built-in protection.
Once the lung is removed, the now-empty chest cavity gradually fills with fluid over the following days and weeks. The body eventually replaces this fluid with scar tissue, and the remaining lung and heart shift slightly toward the empty space.
Risks and Complications
Pneumonectomy carries significant surgical risk. A large single-center study found the 30-day mortality rate was 4.3%, rising to 9.1% at 90 days. The most dangerous complication is a bronchopleural fistula, an abnormal opening where the sealed bronchial stump breaks down and leaks air or fluid into the chest cavity. Patients who developed this complication had roughly five times the risk of death in both the short and longer term.
Other notable risk factors for poor outcomes included prolonged time on a ventilator (more than 48 hours after surgery) and cancer that had invaded the chest wall. These findings underscore why careful patient selection matters so much.
Post-pneumonectomy syndrome is a less common but serious late complication. After the lung is removed, the heart and remaining airways can shift dramatically into the empty space. Over time, this shifting causes the windpipe and remaining main airway to twist and compress against the spine or aorta, leading to gradually worsening shortness of breath. It occurs most often after right-sided pneumonectomies because the heart has more room to rotate in that direction. Diagnosis typically involves a CT scan showing the extent of the mediastinal shift, and surgical correction with implants to stabilize the chest cavity may be needed.
Recovery After Surgery
The early recovery period is closely monitored, usually starting in the ICU. Pain management, chest drainage, and careful fluid balance are all critical in the first few days. In the weeks following surgery, you can gradually begin light, non-strenuous activity. Patients who recover without major complications can often return to a desk job or similar work within about eight weeks.
Full recovery takes considerably longer. Your remaining lung needs time to compensate, and your body has to adjust to operating at a lower respiratory capacity. Research tracking patients after major lung surgery found that breathing capacity dropped to roughly 79% of pre-surgical levels at three months, recovered slightly to about 83% by one year, and then plateaued. The encouraging finding is that actual exercise capacity recovered to approximately 95% of baseline within a year. In practical terms, this means your lung function tests will look worse on paper, but your ability to do everyday activities recovers much more than the numbers suggest.
Life with One Lung
Most people who undergo a pneumonectomy can live active, independent lives afterward. The remaining lung gradually expands to fill more of the chest cavity and becomes more efficient over time. You won’t have the same exercise tolerance as someone with two healthy lungs, and activities like running or climbing steep hills will feel harder. But walking, light exercise, household tasks, and most daily routines are well within reach for the majority of patients.
Altitude and air travel deserve some thought. Lower oxygen levels at high elevations or in airplane cabins can be more noticeable when you have one lung, and some people benefit from supplemental oxygen during flights. Respiratory infections also become a bigger concern, since you have less reserve to handle the added strain on your breathing. Staying current on vaccinations and avoiding prolonged exposure to respiratory illness helps protect that single working lung for the long term.