Although there is certainly a benefit to breathing with two lungs, it is possible to live with just one. Surgery to remove one lung may be performed for lung cancer, trauma, or lung disease.
The lungs are responsible for bringing oxygen into the body and moving carbon dioxide out. Oxygen is needed for the body’s cells to produce energy. As a result of that energy-producing process, carbon dioxide is made, which can be toxic and needs to be removed from the body.
When you take a deep breath, the large muscle under the lungs, called the diaphragm, contracts to allow the lungs to expand and fill with air. The air travels into the lungs, down into the small air sacs called alveoli.
There are many small blood vessels, called capillaries, near the alveoli, which contain red blood cells that carry a protein called hemoglobin. Hemoglobin carries both carbon dioxide and oxygen.
Hemoglobin releases carbon dioxide in the alveoli (to be exhaled) and picks up oxygen to transport around the body. In the tissues, hemoglobin releases oxygen and picks up carbon dioxide to return to the lungs.
This article will review the need for surgical removal of a lung, called a pneumonectomy, as well as the risks, complications, and what happens during the surgery.
What Is a Pneumonectomy?
A pneumonectomy is the surgical removal of one of the two lungs. During a pneumonectomy, a surgeon makes an incision on your side, through which the lung is removed. Lymph nodes near the lung may also be removed.
The body is generally able to function with just one lung. But in order to perform a pneumonectomy in the safest way possible, extensive testing must be done before surgery to ensure the remaining lung will be able to maintain oxygenation for the body.
Pulmonary function tests measure the volume of air the lungs can move and how well they diffuse oxygen into the blood. A ventilation perfusion scan (an X-ray using a tracer gas) may also be done. This scan can show how well each lung functions in terms of blood supply to the lungs and how much air they can breathe.
When Is a Pneumonectomy Necessary?
A pneumonectomy is most often performed to treat lung cancer. The most common type of lung cancer requiring a pneumonectomy is non-small cell lung cancer (NSCLC), but it may also be done for mesothelioma.
A pneumonectomy is usually only performed for primary lung cancer, which is cancer that starts in the lung. It is rarely an option when cancer has spread (metastasized) into the lung from a different primary site (such as the breast or prostate).
When lung cancer occurs in one of the major airways, called the main-stem bronchus, pneumonectomy may be the only way the cancer can be removed.
Trauma, such as a blunt force injury or something penetrating the lung, may require a pneumonectomy. There is a high risk of mortality when a pneumonectomy is needed for this reason.
Pneumonectomy may also be performed for inflammatory lung diseases such as pulmonary tuberculosis, fungal lung infection, and bronchiectasis (permanent widening of the airways due to inflammation or infection). There is a high risk of complications, so this procedure is usually reserved for those who can tolerate such an aggressive treatment.
Risks and Complications
A pneumonectomy is an aggressive surgical procedure that carries a risk of serious complications, including:
- Heart arrhythmias: After a pneumonectomy, the heart may experience an abnormal rhythm, most commonly atrial fibrillation. In this rhythm, the top part of the heart (atria) beats too quickly, causing a heartbeat that is too fast and irregular.
- Pneumonia: A bacterial lung infection in the remaining lung is common after pneumonectomy. This is due to the risk of bacteria entering the lung while being hospitalized and undergoing multiple medical procedures.
- Pulmonary embolism (PE): A pulmonary embolism is a blood clot that has lodged in the blood vessels in the lungs. This can be a potentially life-threatening complication after pneumonectomy.
- Pulmonary edema: This is a condition in which fluid collects in the lungs, causing shortness of breath. It can be difficult for adequate gas exchange to happen, and this can lead to further complications.
- Empyema: After the lung is removed, the space left behind can fill with fluid. It is possible that this fluid can become infected. This infection can cause a pus-filled area, called an empyema, to form.
- Bronchopleural fistula (BPF): A bronchopleural fistula is a connecting opening that forms between the lining of the lung (pleura) and the airway. This can happen after pneumonectomy in the area called the stump, where the major airway has been closed off after the lung was removed.
What Happens During a Pneumonectomy?
A pneumonectomy can be done with one of two approaches; a thoracotomy, in which a large incision is made between two ribs to open the chest, or a VATS (video-assisted thoracic surgery), which is less invasive.
During a pneumonectomy, you will be given anesthesia, and the healthy lung is ventilated to assist with breathing. You are placed in the proper position for whichever type of surgical procedure will be used. Your chest is accessed through either one large incision or the smaller incisions used for VATS.
The lung is deflated and removed by the surgeon. The remaining airway will be closed off, forming a stump so that air doesn’t enter the newly formed cavity. Lymph nodes in the chest may also be removed during surgery to see if any cancer cells are present.
When removal is complete, the surgeon will close the wounds made in the chest wall muscles and skin, and a dressing will be applied. A chest tube may be left in place for a few days after surgery to help the cavity drain any fluid that builds up.
After surgery, the person is moved to the intensive care unit, where they will be monitored.
In the immediate postoperative period, you may feel very tired and uncomfortable. Taking pain medications as needed can help with post-op pain. Drains and intravenous lines will be removed after a few days.
Pulmonary rehabilitation will likely be ordered as part of the long-term recovery from a pneumonectomy. During pulmonary rehabilitation, different breathing techniques are taught. Activity and exercise are increased gradually to be sure they are done safely. This can help you recover in a safer, more effective way after pneumonectomy.
Your outlook after pneumonectomy can depend on any complications you experience following surgery and the recurrence of cancer.
Studies show that approximately 37% of people undergoing pneumonectomy will have postoperative complications. Those who have a left pneumonectomy often do better following surgery. The anatomical differences between the left and right lungs make a right pneumonectomy a higher risk for postoperative complications.
In a study of people with lung cancer who had pneumonectomy, those with NSCLC had a 52% three-year survival rate, and those with small cell lung cancer had a 38% three-year survival.
A person can live with one lung. A pneumonectomy is the surgical removal of an entire lung, most often due to lung cancer. It is performed by a thoracic surgeon, who may do the surgery through one larger incision or several smaller incisions and the use of a camera.
After surgery, some complications can include infection, blood clots, and abnormal heart rhythms.
A Word From Verywell
Taking good care of yourself is important when facing an upcoming surgery such as a pneumonectomy. Ask your surgeon about anything specific you need to do before surgery. Eating a healthy diet and getting regular exercise can help keep your body in the best shape possible for this major surgery.
Frequently Asked Questions
Can a lung grow back?
No, lungs cannot grow back once they are removed.
What organs can you live without?
In addition to living with only one lung, it is possible to live without other organs in the body. Though not ideal, the body can still function without them, though some complications may occur. These other organs can include:
- One kidney
What happens if one lung is damaged?
If one lung is damaged, it is possible to live with only one functioning lung.
National Heart, Lung, and Blood Institute. What breathing does for the body.
University of Rochester. Pneumonectomy.
American Lung Association. Lung function tests.
MedlinePlus. Pulmonary ventilation/perfusion scan.
Yan S, Gritsiuta AI, Rosal GM del, Jones G, Rocco G, Jones DR. Pneumonectomy for lung cancer. Shanghai Chest. 2020;4(0). doi:10.21037/shc.2019.12.05
Philips B., Turco L., Mirzaie M, Fernandez C. Trauma pneumonectomy: a narrative review. Int J Surg. 2017;46: 71-74. doi:10.1016/j.ijsu.2017.08.570
Johns Hopkins Medicine. Pneumonectomy.
Waguaf S, Boubia S, Idelhaj N, Fatene A, Ridai M. Video-assisted thoracoscopic pneumonectomy for destroyed lung. Asian Cardiovasc Thorac Ann. 2021 Feb;29(2):111-115. doi:10.1177/0218492320974516
Campisi A, Bertolaccini L, Luo J, Stella F, Fang W. Management of medical complications after pneumonectomy. Shanghai Chest. 2020;4(0). doi:10.21037/shc.2019.10.10
Haam S. Video-assisted thoracic surgery pneumonectomy. J Chest Surg. 2021;54(4):253-257. doi:10.5090/jcs.21.064
National Heart, Lung, and Blood Institute. Pulmonary rehabilitation.
Gu C, Wang R, Pan X, et al. Comprehensive study of prognostic risk factors of patients underwent pneumonectomy. J Cancer. 2017;8(11):2097-2103. doi:10.7150/jca.19454
Mount Sinai. Splenectomy.
Cedars Sinai. Appendicitis,
MedlinePlus. Laparoscopic gallbladder removal.
Price AM, Moody WE, Stoll VM, et al. Cardiovascular effects of unilateral nephrectomy in living kidney donors at 5 years. Hypertension. 2021;77(4):1273-1284. doi:10.1161/HYPERTENSIONAHA.120.15398
Tan Z. Recent advances in the surgical treatment of advanced gastric cancer: a review. Med Sci Monit. 2019;25:3537-3541. doi:10.12659/MSM.916475
Thanks for your feedback!
What is your feedback?