Lobectomy versus pneumonectomy

What it is

A lobectomy removes one lobe; a pneumonectomy removes the entire lung. The impact on lung function is moderate, or less severe, after a lobectomy and severe, or more severe, after a pneumonectomy. The indication for a lobectomy is localized disease and for a pneumonectomy extensive or central disease, and the risk is lower with the lobectomy and higher with the pneumonectomy. The surgical approach is VATS or thoracotomy for a lobectomy and thoracotomy for a pneumonectomy. A lobectomy is preferred when possible to preserve lung function, whereas a pneumonectomy is a last resort when the disease is too extensive for a lobectomy.

How it is treated

The indications for a pneumonectomy are a neoplastic process, localized fibrosis or bronchiectasis, infection such as TB or an abscess, and trauma.

Pre-op investigations are PFT with spirometry and diffusing capacity, with an FEV1 above 1.5-2 L, echo to assess the pulmonary arterial pressure, and exercise testing, and pre-op physiotherapy is done. Post-op the CXR is repeated, the patient is kept NPO on an NG tube to prevent aspiration and pulmonary edema, and analgesia, antibiotics and anti-coagulation are given, since the risk of PE post-op is high.