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CION Cancer Clinics
Pneumonectomy: what removing a whole lung involves | CION Cancer Clinics
A pneumonectomy removes one whole lung, left or right, usually through a cut between the ribs while you are fully asleep. The surgeon closes off the main airway and blood vessels, takes out the lung and checks the nearby lymph nodes. Your other lung then does all the breathing. This page walks through the day, the types of operation, the first days after and what it cannot tell you. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What actually happens in a pneumonectomy?
- What happens, from the ward to waking up?
- Is every pneumonectomy the same operation?
- Which words will you see, and what do they mean?
- What are the first days after the operation like?
- What do families often get wrong about this operation?
- Common questions about pneumonectomy surgery
The short answer
What actually happens in a pneumonectomy?
In a pneumonectomy the surgeon removes one whole lung, left or right, through a cut in the side of the chest. The main airway and the main blood vessels to that lung are closed off and cut, the lung is lifted out, and the nearby lymph nodes are taken for testing.
Why it is a bigger operation than most lung surgery
Most lung cancer operations remove only one lobe, which is one section of a lung. Removing the whole lung means your heart and your other lung have to take on all the work from the moment you wake up. That is why the checks before the operation are more thorough, and why the first days afterwards are watched so closely.
What stays behind in your chest
The space where the lung was does not stay empty. Over the following weeks it slowly fills with fluid, which later thickens. The heart and the other organs in the middle of the chest shift a little towards that side. This is expected and is part of how the body settles.
This page describes the operation in general. It cannot tell you whether a pneumonectomy is right for you. That decision belongs to your treating team, who know your scans and your fitness.On the day
What happens, from the ward to waking up?
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Final checks on the ward
You will be asked not to eat for some hours beforehand. A nurse checks your consent form, marks the side of the chest, and fits stockings to lower the chance of clots in your legs.
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Anaesthesia and a pain line
You are fully asleep. Many teams also place a thin tube near the spine or along the ribs to numb the chest for the first few days. A special breathing tube lets the anaesthetist rest the lung being removed while the other lung keeps breathing.
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Opening the chest
You lie on your side. Most whole-lung operations use one longer cut between the ribs, called a thoracotomy. Some centres use keyhole cuts with a camera where the tumour allows it.
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Removing the lung
The surgeon ties and divides the artery and veins, then closes the main airway with staples or stitches. The lung comes out, and lymph nodes in the centre of the chest are removed for the pathologist.
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Closing and waking
A drain may be left in the chest for a short time. You wake in recovery or intensive care, with oxygen, a drip and monitoring wires.
Not sure whether this applies to you?
Ask an oncologistNot all the same
Is every pneumonectomy the same operation?
No. The name covers a few different operations. Your consent form should say which one is planned, and it is fair to ask.
Standard pneumonectomy
The whole lung is removed inside its thin lining, with the nearby lymph nodes. This is what most people mean by the word, and it is the usual operation when lung cancer sits close to the root of the lung.
Sleeve or carinal pneumonectomy
Used when the tumour reaches the point where the windpipe divides. Part of that junction is removed too, and the airway is joined back together. It is a longer and more specialised operation.
Extrapleural pneumonectomy
The lung, its lining, part of the diaphragm and sometimes the sac around the heart are removed. It is now rarely done, mainly for selected people with mesothelioma, a cancer of the chest lining.
Completion pneumonectomy
The rest of a lung is removed after an earlier operation took part of it, usually because the cancer has come back in that lung.
On your consent form
Which words will you see, and what do they mean?
- Thoracotomy
- The cut between the ribs on the side of the chest that gives the surgeon access to the lung.
- Bronchial stump
- The closed end of the main airway after the lung is removed. Healing of this closure is watched carefully after surgery.
- Pleural space
- The space inside the chest wall where the lung used to sit. After the operation it slowly fills with fluid.
- Mediastinal lymph nodes
- Small glands in the middle of the chest. They are removed and checked to see whether cancer has reached them, which guides later treatment.
- Margin
- The rim of healthy tissue around the tumour. A clear margin means no cancer cells were found at the cut edge.
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Straight after
What are the first days after the operation like?
Expect to be breathless and sore, and to be got out of bed sooner than feels reasonable. Sitting up, deep breaths and short walks help the remaining lung stay clear. A physiotherapist will usually visit each day to teach breathing and coughing exercises.
What the team is watching for
Nurses check your breathing, oxygen level, heart rhythm and fluid balance many times a day. Fluid through the drip is kept on the low side, because the single lung is sensitive to too much. A fast or irregular heartbeat is fairly common in the first week and is usually treated with medicine. A leak from the closed airway is less common but serious, and it is one reason you are asked to report a new cough bringing up thin, salty-tasting fluid.
Who this operation does not suit
A pneumonectomy is not offered when the cancer has already spread to distant organs, or when tests show the heart or other lung could not manage the extra load. In those situations a smaller operation, radiotherapy or medicines may be discussed instead.
Your stay is usually longer than after a smaller lung operation. Your team will tell you what to expect for your own case.
Did you know
Surgery for lung cancer is rarely decided by one doctor. At CION each case is discussed at a tumour board, where surgical, medical and radiation oncologists look at the scans together before the plan is confirmed.
Commonly believed
What do families often get wrong about this operation?
"With only one lung, he will be bedridden."
Most people who are fit enough to be offered the operation go on to walk, look after themselves and do everyday tasks. Breathlessness on hills and stairs is common. Being confined to bed is not the expected outcome, and the tests beforehand exist to check this.
"The empty space will fill with air and collapse the other side."
The space fills gradually with fluid, and the organs in the middle of the chest move across a little. This is the normal way the chest settles, and your team follows it on chest X-rays.
"Opening the chest lets the cancer spread."
Surgery does not make cancer spread through exposure to air. Delaying a planned operation for this reason gives the cancer time to grow, which does change the outcome.
"If the whole lung is removed, no more treatment is needed."
Sometimes that is true. Often the pathology report on the lung and lymph nodes leads the team to suggest chemotherapy, immunotherapy or radiotherapy afterwards, to lower the chance of the cancer coming back.
Questions we are asked
Common questions about pneumonectomy surgery
How long does the operation take?
It usually takes several hours, including the time spent on anaesthesia and the pain line before the first cut. Operations that involve the windpipe junction or the chest lining take longer. Your family will wait outside, and the team normally speaks to them once you are in recovery.
Will I be on a ventilator afterwards?
Most people have the breathing tube removed at the end of the operation and breathe on their own with oxygen through a mask or small tubes in the nose. A breathing machine is used for longer only if there are problems. Your anaesthetist can tell you what is planned for your own case.
How much will it hurt?
A thoracotomy is one of the more uncomfortable cuts, because it passes between the ribs. That is why a nerve block or a spinal pain line is often used for the first days, followed by tablets. Tell the nurses early if pain stops you coughing or breathing deeply, because that affects the lung.
Can it be done by keyhole surgery?
Sometimes. A keyhole or robot-assisted pneumonectomy is possible in selected cases, depending on where the tumour sits and how the blood vessels look. Many whole-lung operations are still done through an open cut. Ask your centre which approach they plan for you, and why.
Why is my chest drain treated differently?
After a smaller lung operation the drain lets out air while the lung re-expands. After a whole-lung operation there is no lung to re-expand, and the space is meant to fill with fluid. The drain, if one is used, is often clamped or removed early, and suction is usually avoided.
Will my voice change?
It can. A nerve that controls one of the vocal cords runs close to the lung, especially on the left. If it is bruised or has to be removed with the cancer, the voice may sound hoarse or weak. It sometimes improves with time, and there are treatments if it does not.
What will the pathology report tell us?
It confirms the type of cancer, its size, whether the margins are clear and whether any removed lymph nodes contain cancer. Together these set the final stage, which guides whether further treatment is suggested. It is normally discussed with you at a follow-up appointment rather than read out on the ward.
Is pneumonectomy covered by Aarogyasri or insurance?
Lung cancer surgery is often covered when it is part of an approved treatment plan. Aarogyasri, CGHS, ECHS, EHS and most cashless insurers are accepted at CION. What you pay depends on your scheme, your room and your stay. Call the helpline with your card details and we will check your own cover.
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Dr. C. Raghavendra Reddy
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Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- Cancer Research UK — Surgery for lung cancer
- American Cancer Society — Surgery for non-small cell 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
When is a whole lung removed?Why the team chooses this over a smaller operationTests to check you can tolerate losing a lungThe breathing and heart tests done beforehandRecovery timeline after pneumonectomyWhat the weeks after going home look likeICU and the first days after surgeryWires, oxygen and monitoring explainedPneumonectomyEvery page about whole-lung removal
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