Pneumonectomy

Pneumonectomy
Intervention
Appearance of the cut surface of a pneumonectomy specimen containing lung cancer, here a squamous cell carcinoma (the whitish tumor near the bronchi).
ICD-9-CM	32.5
MeSH	D011013

A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung. Removal of just one lobe of the lung is specifically referred to as a lobectomy, and that of a segment of the lung as a wedge resection (or segmentectomy).

Indications

A chest x-ray of a person who has had their right lung removed

The most common reason for a pneumonectomy is to remove tumourous tissue arising from lung cancer. In the days prior to the use of antibiotics in tuberculosis treatment, tuberculosis was sometimes treated surgically by pneumonectomy.

The operation will reduce the respiratory capacity of the patient; before conducting a pneumonectomy, the surgeon will evaluate the ability of the patient to function after the lung tissue is removed. After the operation, patients are often given an incentive spirometer to help exercise their remaining lung and to improve breathing function.

A rib or two is sometimes removed to allow the surgeon better access to the lung.

Types

Diagram showing the parts removed in a pneumonectomy

There are two types of pneumonectomy:

Simple pneumonectomy: removal of just the affected lung
Extrapleural pneumonectomy (EPP): removal of the affected lung, plus part of the diaphragm, the parietal pleura (lining of the chest) and the pericardium (lining of the heart) on that side.^[1] The linings are replaced by Gore-Tex in this radical and painful surgery that is used primarily for treatment of malignant mesothelioma.

History

Pioneering dates

1895: first pneumonectomy in multiple stages by William Macewen on a patient with tuberculosis and emphysema
1912: first anatomical dissection lobectomy by Hugh Morriston Davies^[2]
1918: first successful lobectomy, by Harold Brunn^[3]
1931: first successful pneumonectomy in two stages by Rudolph Nissen on a patient with crush injury to the thorax
1933: first successful single-stage total pneumonectomy by Graham and Singer^[4]
1939: first segmentectomy, by Churchill and Belsey^[5]

References

↑ http://www.cancer.gov/templates/db_alpha.aspx?CdrID=367446
↑ Naef, A (1993). "Hugh Morriston Davies: First Dissection Lobectomy in 1912". Annals of Thoracic Surgery. 56 (4): 988–989. doi:10.1016/0003-4975(93)90377-t. PMID 8215687.
↑ Rosenthal, R; Zenilman M (2001). "Principles and Practice of Geriatric Surgery". Springer: 393.
↑ Horn, L; Johnson DH (July 2008). "Evarts A. Graham and the first pneumonectomy for lung cancer". Journal of Clinical Oncology. 26 (19): 3268–3275. doi:10.1200/JCO.2008.16.8260. PMID 18591561.
↑ Churchill, E; Belsey R (1939). "Segmental Pneumonectomy in Bronchiectasis: The Lingula Segment of the Left Upper Lobe". Annals of Surgery. 109 (4): 481–499. doi:10.1097/00000658-193904000-00001. PMC 1391296. PMID 17857340.

External links

Fuentes PA (April 2003). "Pneumonectomy: historical perspective and prospective insight". Eur J Cardiothorac Surg. 23 (4): 439–45. PMID 12694756.

Tests, surgery and other procedures involving the respiratory system (ICD-9-CM V3 21–22, 30–34, ICD-10-PCS 0B)

Upper RT	nose Rhinoplasty Septoplasty Alarplasty Rhinectomy Rhinomanometry sinus Sinusotomy larynx Laryngoscopy Laryngectomy Laryngotomy Thyrotomy

Lower RT	trachea Cricothyrotomy Tracheoesophageal puncture Tracheotomy bronchus Bronchoscopy lung Pneumonectomy Lobectomy Wedge resection Lung transplantation Decortication of lung Heart-lung transplant

Chest wall, pleura, mediastinum, and diaphragm	pleura/pleural cavity Thoracentesis Pleurodesis Thoracoscopy Thoracotomy Chest tube mediastinum Mediastinoscopy Nuss procedure

Medical imaging	Bronchography CT pulmonary angiogram High resolution CT Spiral CT Ventilation/perfusion scan

CPRs	Pneumonia severity index CURB-65

Lung function test	Body plethysmography Spirometry Bronchial challenge test Capnography Diffusion capacity

Cytology	Sputum culture Bronchoalveolar lavage

Respiratory therapy/ intubation	Mechanical ventilation Positive pressure ventilation Artificial respiration Nebulizer Hyperbaric medicine Oxygen therapy Decompression chamber Heliox Negative pressure ventilator Postural drainage CPR

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