Pneumonectomy

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).

Pneumonectomy
Lung cancer
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-CM32.5
MeSHD011013

Indications

PneumonectomyXray
A chest x-ray of a person who has had their left 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 removal of a whole lung (pneumonectomy) CRUK 365
Diagram showing the parts removed in a pneumonectomy

There are two types of pneumonectomy:

  1. Simple pneumonectomy: removal of just the affected lung
  2. 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]

See also

References

  1. ^ Opitz I, Weder W (June 2017). "A nuanced view of extrapleural pneumonectomy for malignant pleural mesothelioma". Annals of Translational Medicine. 5 (11): 237. doi:10.21037/atm.2017.03.88. PMC 5497104. PMID 28706905.
  2. ^ 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. Archived from the original on 2013-07-04.
  3. ^ Rosenthal, R; Zenilman M (2001). "Principles and Practice of Geriatric Surgery". Springer: 393.
  4. ^ 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.
  5. ^ 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

Adenocarcinoma in situ of the lung

In situ pulmonary adenocarcinoma (AIS)—previously included in the category of "bronchioloalveolar carcinoma" (BAC)—is a subtype of lung adenocarcinoma. It tends to arise in the distal bronchioles or alveoli and is defined by a non-invasive growth pattern. This small solitary tumor exhibits pure alveolar distribution (lepidic growth) and lacks any invasion of the surrounding normal lung. If completely removed by surgery, the prognosis is excellent with up to 100% 5-year survival.Although the entity of AIS was formally defined in 2011 (see History), it represents a noninvasive form of pulmonary adenocarcinoma which has been recognized for some time. AIS is not considered to be an invasive tumor by pathologists, but as one form of carcinoma in situ (CIS). Like other forms of CIS, AIS may progress and become overtly invasive, exhibiting malignant, often lethal, behavior. Major surgery, either a lobectomy or a pneumonectomy, is usually required for treatment.

Bronchopleural fistula

A bronchopleural fistula (BPF) is a fistula between the pleural space and the lung. It can develop following Pneumonectomy, post traumatically, or with certain types of infection. It may also develop when large airways are in communication with the pleural space following a large pneumothorax or other loss of pleural negative pressure, especially during positive pressure mechanical ventilation. On imaging, the diagnosis is suspected indirectly on radiograph. Increased gas in the pneumonectomy operative bed, or new gas within a loculated effusion are highly suggestive of the diagnosis. Infectious causes include tuberculosis, Actinomyces israelii, Nocardia, and Blastomyces dermatitidis. Malignancy and trauma can also result in the abnormal communication.

Charles Drew (surgeon)

Charles Edwin Drew (15 December 1916 – 31 May 1987) was a cardiothoracic surgeon best known for assisting Sir Clement Price Thomas in King George VI's pneumonectomy in 1951.

He went on to conduct pioneering research on profound hypothermia in cardiac surgery and what came to be known as the 'Drew technique'.

Drew died from throat cancer at the age of 70 in 1987, leaving his wife Maureen and two children.

Evarts Ambrose Graham

Evarts Ambrose Graham, M.D., F.A.C.S. (1883–1957) was an American academic, physician, and surgeon.

Heather Von St James

Heather Von St. James (born January 5, 1969) is an American cancer survivor, cancer research advocate, and blogger. Von St. James serves as a mesothelioma research funding advocate and conference speaker for the Asbestos Disease Awareness Organization and Mesothelioma Applied Research Foundation.Von St. James was diagnosed with malignant mesothelioma in 2005 at the age of 36. She received her diagnosis just after the birth of her first child, Lily.In February 2006, Von St. James underwent extensive thoracic surgery, known as extrapleural pneumonectomy, with adjuvant intra-operative heated chemotherapy under the care of thoracic surgeon Dr. David J. Sugarbaker at the Brigham and Women's Hospital in Boston, Massachusetts. She was declared cancer-free later that year.

Von St. James’ recovery from the disease is clinically unique because malignant mesothelioma is a rare, aggressive cancer typically diagnosed in older patients that, even with treatment, has a 6 to 9 month median survival rate. Mesothelioma, commonly caused by exposure to asbestos, typically only manifests after a 25-30-year latency period following exposure.

High Fowler's position

The High Fowler's position is a position in which a patient, typically in a hospital, is placed when the head of the bed needs to be elevated as high as possible. The upper half of the patient's body is between 60 degrees and 90 degrees in relation to the lower half of their body. The legs of the patient may be straight or bent.This position is also required postoperatively for pneumonectomy patients. This position is known colloquially as "sitting".

List of -ectomies

The surgical terminology suffix "-ectomy" was taken from Greek εκ-τομια = "act of cutting out". It means surgical removal of something, usually from inside the body.

List of surgeries by type

This is a list of surgeries and surgical procedures by type (including ectomy, stomy, and otomy)

Lung cancer

Lung cancer, also known as lung carcinoma, is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. This growth can spread beyond the lung by the process of metastasis into nearby tissue or other parts of the body. Most cancers that start in the lung, known as primary lung cancers, are carcinomas. The two main types are small-cell lung carcinoma (SCLC) and non-small-cell lung carcinoma (NSCLC). The most common symptoms are coughing (including coughing up blood), weight loss, shortness of breath, and chest pains.The vast majority (85%) of cases of lung cancer are due to long-term tobacco smoking. About 10–15% of cases occur in people who have never smoked. These cases are often caused by a combination of genetic factors and exposure to radon gas, asbestos, second-hand smoke, or other forms of air pollution. Lung cancer may be seen on chest radiographs and computed tomography (CT) scans. The diagnosis is confirmed by biopsy which is usually performed by bronchoscopy or CT-guidance.Avoidance of risk factors, including smoking and air pollution, is the primary method of prevention. Treatment and long-term outcomes depend on the type of cancer, the stage (degree of spread), and the person's overall health. Most cases are not curable. Common treatments include surgery, chemotherapy, and radiotherapy. NSCLC is sometimes treated with surgery, whereas SCLC usually responds better to chemotherapy and radiotherapy.Worldwide in 2012, lung cancer occurred in 1.8 million people and resulted in 1.6 million deaths. This makes it the most common cause of cancer-related death in men and second most common in women after breast cancer. The most common age at diagnosis is 70 years. Overall, 17.4% of people in the United States diagnosed with lung cancer survive five years after the diagnosis, while outcomes on average are worse in the developing world.

Mesothelioma

Mesothelioma is a type of cancer that develops from the thin layer of tissue that covers many of the internal organs (known as the mesothelium). The most common area affected is the lining of the lungs and chest wall. Less commonly the lining of the abdomen and rarely the sac surrounding the heart, or the sac surrounding the testis may be affected. Signs and symptoms of mesothelioma may include shortness of breath due to fluid around the lung, a swollen abdomen, chest wall pain, cough, feeling tired, and weight loss. These symptoms typically come on slowly.More than 80% of mesothelioma cases are caused by exposure to asbestos. The greater the exposure the greater the risk. As of 2013, about 125 million people worldwide have been exposed to asbestos at work. High rates of disease occur in people who mine asbestos, produce products from asbestos, work with asbestos products, live with asbestos workers, or work in buildings containing asbestos. Asbestos exposure and the onset of cancer are generally separated by about 40 years. Washing the clothing of someone who worked with asbestos also increases the risk. Other risk factors include genetics and infection with the simian virus 40. The diagnosis may be suspected based on chest X-ray and CT scan findings, and is confirmed by either examining fluid produced by the cancer or by a tissue biopsy of the cancer.Prevention centers around reducing exposure to asbestos. Treatment often includes surgery, radiation therapy, and chemotherapy. A procedure known as pleurodesis, which involves using substances such as talc to scar together the pleura, may be used to prevent more fluid from building up around the lungs. Chemotherapy often includes the medications cisplatin and pemetrexed. The percentage of people that survive five years following diagnosis is on average 8% in the United States.In 2015, about 60,800 people had mesothelioma, and 32,000 died from the disease. Rates of mesothelioma vary in different areas of the world. Rates are higher in Australia, the United Kingdom, and lower in Japan. It occurs in about 3,000 people per year in the United States. It occurs more often in males than females. Rates of disease have increased since the 1950s. Diagnosis typically occurs after the age of 65 and most deaths occur around 70 years old. The disease was rare before the commercial use of asbestos.

Pericardium

The pericardium is a double-walled sac containing the heart and the roots of the great vessels. The pericardial sac has two layers, a serous layer and a fibrous layer. It encloses the pericardial cavity which contains pericardial fluid.

The pericardium fixes the heart to the mediastinum, gives protection against infection and provides the lubrication for the heart. It receives its name from Ancient Greek peri (περί; "around") and cardion (κάρδιον; "heart").

Peter Jones (surgeon)

Peter Henry Jones (1 March 1917 – 30 July 1984), was born in Monmouth and is best known for his role in assisting Sir Clement Price Thomas in the pneumonectomy of King George VI in 1951.

He subsequently remained professionally close to Price Thomas, pursuing a career in cardiothoracic surgery.

Raja M. Flores

Raja Michael Flores, M.D., is an American thoracic surgeon, currently Chief of the Division of Thoracic Surgery at Mount Sinai Hospital and Ames Professor of Cardiothoracic Surgery at the Icahn School of Medicine at Mount Sinai, both in New York City.

Regius Professor of Surgery (Glasgow)

The Regius Chair of Surgery at the University of Glasgow was founded in 1815 by King George III, who also established the Chairs of Chemistry and Natural History.

Notable Professors have included Joseph Lister (1860–1869), who developed antisepsis through the use of phenol in sterlising instruments and in cleaning wounds, and Sir William Macewen, a pioneer in modern brain surgery who contributed to the development of bone graft surgery, the surgical treatment of hernia and of pneumonectomy (removal of the lungs).

The current occupant is Professor William George, who was previously Professor of Surgery (1981–1999).

Rudolph Nissen

Rudolph Nissen (sometimes spelled Rudolf Nissen) (September 5, 1896 – January 22, 1981) was a surgeon who chaired surgery departments in Turkey, the United States and Switzerland. The Nissen fundoplication, a surgical procedure for the treatment of gastroesophageal reflux disease, is named after him. Nissen completed the first pneumonectomy by a Western physician in 1931. In 1948, he performed an abdominal surgery that extended the life of Albert Einstein by several years. He trained under German physicians Ludwig Aschoff and Ferdinand Sauerbruch.

Thoracotomy

A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. It is performed by surgeons (or emergency physicians under certain circumstances) to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine (the latter may be necessary to access tumors in the spine). The purpose of a thoracotomy is the first step used to facilitate thoracic surgeries including lobectomy or pneumonectomy for lung cancer or to gain thoracic access in major trauma.

Tracheal deviation

Tracheal deviation is a clinical sign that results from unequal intrathoracic pressure within the chest cavity. It is most commonly associated with traumatic pneumothorax, but can be caused by a number of both acute and chronic health issues, such as pneumonectomy, atelectasis, pleural effusion, fibrothorax (pleural fibrosis), or some cancers (tumors within the bronchi, lung, or pleural cavity) and certain lymphomas associated with the mediastinal lymph nodes.

In most adults and children, the trachea can be seen and felt directly in the middle of the anterior (front side) neck behind the jugular notch of the manubrium and superior to this point as it extends towards the larynx. However, when tracheal deviation is present, the trachea will be displaced in the direction of less pressure. Meaning, that if one side of the chest cavity has an increase in pressure (such as in the case of a pneumothorax) the trachea will shift towards the opposing side.The trachea is the tube that carries air from the throat to the lungs. It is also commonly referred to as the windpipe. The trachea is one of the most important parts of the respiratory system and damage to the trachea can indicate a life-threatening emergency. The normal position of the trachea is straight up and down, running along the center of the front side of the throat. Certain conditions can cause the trachea to shift to one side or the other. This is a medical emergency that requires immediate medical attention to discover the cause of the shift and begin an appropriate course of treatment. There are several causes for a tracheal deviation, and the condition often presents along with difficulty breathing, coughing and abnormal breath sounds. The most common cause of tracheal deviation is a pneumothorax, which is a collection of air inside the chest, between the chest cavity and the lung. A pneumothorax can be spontaneous, caused by existing lung disease, or by trauma. Treatment varies, depending on the severity of the pneumothorax. Smaller pockets of air tend to dissipate on their own, while larger areas can cause complications and are usually vented by a needle in the chest. As soon as the pneumothorax is treated, the tracheal deviation also will resolve itself. A congenital lack of one lung, surgical removal of a lung or pleural fibrosis, which is an inflammation of the lung membranes caused by an infection. As a result of the wide range of causes of tracheal deviation, it is absolutely essential to seek medical attention in order to obtain an accurate diagnosis.

VATS lobectomy

Video-assisted thoracoscopic surgery (VATS) lobectomy is an approach to lung cancer surgery.

William Macewen

Sir William Macewen, CB, FRS, () (22 June 1848 – 22 March 1924) was a Scottish surgeon. He was a pioneer in modern brain surgery and contributed to the development of bone graft surgery, the surgical treatment of hernia and of pneumonectomy (removal of the lungs).

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