Post Pneumonectomy Complications

Author: Paul Schipper, MD
Institution: OHSU
Date Reviewed: June 2025
Original Case: Raghav Murthy, MD; Derek Willims, MD; David Graham, MD; Brian Bethea, MD / University of  Texas Southwestern
Learning Domain: General Thoracic
Learning Objective: Indications for Pneumonectomy; Complications of Pneumonectomy
PowerPoint File: Post Pneumonectomy Complications

 

Discussion Points for Conference

  • Staging of Disease
  • Role of Surgery
  • Role of Adjuvant therapy
  • Surgical Approaches
  • Expected outcomes
  • Potential complications

 

Sweet’s Rules

  • Protect the blood supply (know the anatomy and avoid damaging the bronchial blood supply)
  • Keep the stump short  to avoid pooling of chronically contaminated secretions.
  • Avoid tension, be mindful of how the stump is closed and sutures that are carefully approximated.
  • Careful approximation.  Each suture should include the mucosa.
  • Avoid closing the stump in areas of inflammation/infection.

 

Principles of Management

  • Protection of remaining lung
  • Control of sepsis
  • Debridement of necrotic tissue
  • Closure of fistula w vascularized tissue
  • Obliteration of the pleural space

 

Learning Points

  • Pneumonectomy  must be performed well
    • Meticulous technique
  • Lung cancer most common after mantle radiation
  • Complications of pneumonexctomy common
    • Both early and late