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Left or right pneumonectomy: why the side matters | CION Cancer Clinics
A right pneumonectomy is generally riskier than a left one. The right lung is larger, so more breathing capacity is lost, and the closed airway on that side is more exposed to leaks. A left pneumonectomy has its own risks, including hoarseness from nerve damage. The cancer decides the side. This page explains the differences, how they change the plan and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Is removing the right lung riskier than removing the left?
- How do the two operations compare?
- Why does the right side carry more risk?
- How does the side change the plan?
- Does a left pneumonectomy have its own problems?
- What should you ask your surgeon about the side?
- What do families often get wrong about left and right?
- Common questions about left and right pneumonectomy
The short answer
Is removing the right lung riskier than removing the left?
Generally, yes. The right lung is larger, so removing it takes away more of your breathing capacity, and large studies have found a higher risk of serious complications after a right pneumonectomy than a left one. The left side carries its own problems, but they tend to be less dangerous.
Why the two sides are not mirror images
The right lung has three lobes and the left has two, because the heart takes up room on the left. The main airways are also shaped differently. The right main airway is shorter and wider. The left is longer and runs beneath the main blood vessel leaving the heart. These differences change how the operation is done and what can go wrong afterwards.
You do not choose the side
The side is decided by where the cancer is. Nobody picks a left operation because it is lower risk. What the side does change is how carefully the team tests your fitness, how they close the airway and how closely they watch you in the first days.
This page describes general patterns. It cannot tell you your own risk, which depends on your tests, your heart, your age and your cancer. Ask your surgeon to explain it for your case.Side by side
How do the two operations compare?
Right pneumonectomy
Left pneumonectomy
Removes the larger lung, with three lobes
Removes the smaller lung, with two lobes
A bigger share of breathing capacity is lost
A smaller share of breathing capacity is lost
Higher risk of a leak from the closed airway
The closed airway sits in a better-protected position
Higher risk of fluid building up in the remaining lung
This problem is less common, though it can still happen
Voice nerve damage is less likely
The voice nerve lies closer, so hoarseness is more likely
The reasons
Why does the right side carry more risk?
Four things add up. None of them means a right-sided operation will go badly; they explain why it is watched so closely.
More lung is lost
The right lung usually does more of the breathing. After it is removed, the smaller left lung must take on a bigger jump in workload, and the heart must push all the blood through it.
A more exposed airway stump
On the right, the closed end of the airway has less natural tissue around it. A leak there, called a bronchopleural fistula, is more common after right-sided operations and is serious.
Fluid in the remaining lung
A rare but dangerous problem, where the one lung fills with fluid in the first days. It has been linked more with right-sided operations, which is one reason drip fluids are carefully limited.
How the chest settles
As the empty space fills, the heart and central structures shift. Very rarely, this pulls on the remaining airway and causes breathlessness months later. This is also described more after right-sided operations.
Not sure whether this applies to you?
Ask an oncologistBefore, during and after
How does the side change the plan?
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Fitness testing
Before a right pneumonectomy, the team pays particular attention to how well the left lung and the heart will cope. A scan showing each lung's share of the work is often more important on this side.
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Closing the airway
Surgeons keep the airway stump short and may cover it with a flap of nearby tissue, especially on the right or after earlier radiotherapy or chemotherapy. Ask your centre how they plan to protect it.
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Fluids and breathing in the first days
Drip fluids are kept low and your breathing and oxygen are watched closely, because the single lung is sensitive to overload.
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Watching the voice after a left operation
If your voice is hoarse or you cough when drinking, tell the team. A swallowing check or an ear, nose and throat review may be arranged.
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Follow-up on both sides
Chest X-rays show how the space is filling. A new cough bringing up salty fluid, or rising breathlessness, is checked straight away on either side.
The other side
Does a left pneumonectomy have its own problems?
Yes. A left pneumonectomy is lower risk in general, but not low risk. It is still a major operation, and the heart and remaining lung still take on all the work.
The voice nerve
On the left, the nerve that controls one vocal cord loops around the main blood vessel from the heart, right beside the lung root and the glands the surgeon removes. If the cancer involves it, or it is stretched during surgery, your voice may become hoarse or weak and your cough less strong. Treatments exist if it does not recover.
Reaching the glands
Some lymph nodes in the centre of the chest are harder to reach from the left side because of the heart and main blood vessels. Your surgeon will explain how they plan to check them.
Heart rhythm
A fast, irregular heartbeat can follow a pneumonectomy on either side. It is usually treated with medicine and often settles.
Take this list with you
What should you ask your surgeon about the side?
- Which side, and why a smaller operation is not possible
- What my tests show about the lung that will remain
- How the airway stump will be closed and protected
- Which complications you watch for most on this side
- What happens if my voice changes after surgery
- Which signs mean I should come back the same day
Commonly believed
What do families often get wrong about left and right?
"The left lung is near the heart, so removing it is more dangerous."
It is the other way round in most studies. The right side usually carries more risk, mainly because the right lung is bigger and its airway stump is more exposed.
"A right pneumonectomy means he will not come through it."
Higher risk does not mean a poor outcome is expected. The team offers the operation only after tests suggest you can cope. Ask them to explain your own risk in plain words.
"They could take the other lung instead, if it is safer."
The cancer decides the side. Removing the healthy lung would leave the cancer in place.
"After a left operation, nothing much can go wrong."
A left pneumonectomy is still a major operation. Leaks, infections, rhythm problems and breathlessness can happen on either side, and the same warning signs apply.
Questions we are asked
Common questions about left and right pneumonectomy
Will I be more breathless after a right pneumonectomy?
Often a little more, because the right lung usually does more of the breathing. How breathless you feel depends mostly on how healthy the remaining left lung is and how fit you were before surgery. Your breathing tests give the team an estimate for your own case.
Is recovery longer on one side?
Recovery is broadly similar, and most of the difference comes from complications rather than the side itself. If a problem such as an airway leak or fluid in the lung develops, the stay is longer. Your team will explain what to expect based on your own fitness.
What is a bronchopleural fistula?
A leak between the closed end of the main airway and the empty chest space. Signs include a new cough bringing up salty or pus-like fluid, fever and rising breathlessness. It is more common after a right pneumonectomy and needs same-day care. Lie on the operated side and get to hospital.
Why is my voice hoarse after a left pneumonectomy?
The nerve to one vocal cord runs close to the left lung root. If it was bruised, stretched or removed with the cancer, the cord may not close well. The voice sometimes recovers over months. An ear, nose and throat doctor can offer treatments if it does not.
Does the side change how I should sleep?
Some teams suggest lying on your back or on the operated side in the early days, so fluid in the empty space does not spill towards the remaining lung. Follow your own team's advice, because practice differs between surgeons.
Does the side affect whether chemotherapy or radiotherapy is given?
The side does not decide further treatment. The pathology report does. It is based on the type of cancer, its stage and the lymph nodes. Your fitness after a larger right-sided operation may affect the timing or choice of treatment, which your oncologist will discuss.
Can we ask for the risk figures for my father's operation?
Yes. It is reasonable to ask your surgeon to explain the main risks for this side, and how your father's own tests change them. Ask them to use plain words and to tell you what they are most watchful for. Write down the answers so the family hears the same thing.
Is a right pneumonectomy covered by Aarogyasri or insurance?
Lung cancer surgery on either side is often covered as part of an approved plan. Aarogyasri, CGHS, ECHS, EHS and most cashless insurers are accepted at CION. Your share depends on your scheme and your stay. Call the helpline with your card details and we will check.
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Sources
- American Cancer Society — Surgery for non-small cell lung cancer
- Cancer Research UK — Surgery for lung cancer
- National Cancer Institute — Non-Small Cell Lung Cancer Treatment (PDQ) - Patient Version
- NHS — Lung cancer: treatment
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Bronchopleural fistula after pneumonectomyThe airway leak that is more common on the rightTests to check you can tolerate losing a lungHow the team measures what the remaining lung can doHeart rhythm problems after lung removalA complication that can follow either sideComplications and red flagsEvery same-day warning sign after cancer surgeryPneumonectomyEvery page about whole-lung removal
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