Pneumonectomy for patients with lung cancer

When lobectomy is not able to completely remove the lesion in patients with lung cancer, pneumonectomy may be considered.

1. Usually suitable for the following situations:

2. Central lung cancer involves the main bronchus;

3. Massive tumors in the lung parenchyma grow across interlobar fissures or invade interlobar blood vessels and lymph nodes;

4. Metastatic lymph nodes involve the main bronchi.

Pneumonectomy, especially right pneumonectomy, can lead to more than half of the lung function and pulmonary vascular bed loss. The surgical risks and complications are greater than those of lobectomy. The surgical mortality rate is about twice that of lobectomy, reaching 4% to 5% or more.

There are 3 types of extended pneumonectomy:

(1) Intrapericardial pneumonectomy is the most commonly used form. It refers to the situation where central lung cancer has invaded the pulmonary artery and vein near the root and it is impossible or inappropriate to ligate the pulmonary vessels outside the pericardium. In this case, the pericardium can be opened to treat the pulmonary artery and vein and perform a pneumonectomy in parallel.

(2) Supra-aortic pneumonectomy When the lesion involves the vicinity of the opening of the left main bronchus and a left pneumonectomy is required, the left main bronchus is removed near the opening, that is, above the aortic arch.

(3) Pneumonectomy with carina reconstruction When the lesion invades the carina or even the distal trachea, it is necessary to remove the lower trachea, carina, one main bronchus and the entire lung (usually the right side), and then anastomose the trachea and the other main bronchus to reconstruct the airway.