In general, you need at least one lung to live. There is one case of a patient who had both lungs removed and was kept alive for six days on life support machines until a lung transplant was performed. This is not a routine procedure, and one cannot live long without both lungs.
However, it is possible to live with just one lung. Pneumonectomy is the surgical removal of an entire lung, usually performed due to diseases such as lung cancer, or injury. Many people with one lung can live to an average life expectancy, but patients are unable to perform vigorous activities and may still experience shortness of breath.
Beaumont’s Multidisciplinary Lung Cancer program offers several different types of treatment for lung cancer. Treatments may include chemotherapy, immunotherapy, radiation, laser therapy (photodynamic therapy or PDT), surgery, or some combination of these (combination treatment/multimodality treatment).
Not all lung cancer will be treated in the same way. Some types of lung cancer are best treated with chemotherapy and radiation, and some examples are best treated with surgery. There are other effective treatments doctors may also use.
Sometimes surgery is necessary and is likely to lead to a cure, and occasionally non-surgical treatments are best. For example, medicine is commonly used to treat non-small cell lung cancer (NSCLC), but small cell lung cancers are often treated with chemotherapy and, if possible, radiation therapy.
Your chances for recovery from heart and lung transplants today are significantly improved since the first transplant operations done in the 70s and 80s. Having lung cancer surgery is a life-altering event, and there is no way to minimize the emotions a person can go through after undergoing a procedure like this. It’s never easy. As with any potentially life-threatening illness, the one sure thing is that the course of a disease is never specific. And that’s not necessarily a bad thing. While we tend to focus on things like the average life expectancy or the average mortality, there is every chance that you, as an individual, could well exceed the averages.
Having lung surgery is ultimately aimed at extending your life. Having a better grasp of what lies ahead can help you focus on what is just as important: your quality of life. It is possible to have only one lung and still function relatively usually. Although the lungs are vital organs in the body, some conditions can cause a person to lose function in their lungs or need to have one removed. That said, each person will be different, and there are special considerations in each case, depending on the person’s lung function and any other issues they experience.
Can you live with one lung?
The lungs are vital organs in the human body, responsible for bringing oxygen into the body and helping get rid of waste gases with every exhale. Though having both lungs is ideal, it is possible to live and function without one lung. Having one lung will still allow a person to live a relatively healthy life.
Having one lung might limit a person’s physical abilities, however, such as their ability to exercise. That said, many athletes who lose the use of one lung may still train and be able to continue their sport.
The body adapts to this change in several ways. For instance, the remaining lung will expand a bit to occupy the space left by the missing lung. Over time, the body will also learn to make up for the loss of oxygen.
However, a person will not have the full lung capacity, as they did with two lungs, and they will likely need to learn to slow down and adapt to this change.
Although most people expect to be continuously winded or have an inability to function without one lung, this is not usually what happens. The person may have to learn to slow their normal functions down to a degree, but they should be able to lead a relatively healthy life with one lung.
Researchers today are paying attention to more than just “life years” or “adverse events” when following patients who have undergone lung cancer surgery. They want to know more about how people feel, how readily they are able to return to a healthy life, and how they perceive their own quality of life.
One study conducted at the Seoul National University Hospital in Korea took a long look at the quality of life of people who had successfully undergone lung cancer surgery versus a matched set of people in the general population who didn’t have cancer.
What they found was that, after an average of five years, individuals treated at stage 0, stage I, phase II, and stage IIIA had no significant difference in daily functioning compared to people in the general public. Moreover, there was no difference in the survival times when comparing the types of surgery people had once they were able to achieve remission.
What this tells us is that it doesn’t matter so much how complicated a surgery or follow-up treatment may be; once a person is deemed cancer-free, the likelihood of living a reasonable quality of life is as good as someone who had undergone less extensive treatment. This is very reassuring as people who are newly diagnosed have to make decisions about surgery. In the past, some people may have opted for a lobectomy instead of a pneumonectomy (or similarly, a wedge resection instead of a lobectomy) thinking that quality of life would be better, even if survival statistics were a bit lower. Fortunately, many people are able to be active, or also climb mountains, with one lung.
- With advances in surgical techniques and immune-suppressing drugs, more than 80% of heart recipients survive more than three years after the operation.
- Lung transplantation is a relatively new procedure that continues to be improved. Currently, more than 65% of lung recipients survive at least three years after a transplant.
Overall, transplantation leads to improvement in your well-being because you regain the ability to carry out normal activities.
Rejection of the transplanted organ and infections are the most severe complications after this procedure. Different complications occur at different times after the operation.
- In the first few weeks after transplantation, bacterial lung infections are common in people who have heart and lung transplantation. These are treated with antibiotics. Fungal infections may also occur early after transplant but are less common.
- In the second month after the operation, cytomegalovirus (CMV) lung infections are common. You may receive antiviral medications to prevent this infection.
- Acute rejection may occur within days after the transplant operation and anytime thereafter.
- Signs of heart rejection include fatigue, swelling of the arms or legs, weight gain, and fever.
- After a heart transplant, you are monitored for acute rejection by taking a tiny piece of the heart muscle called a biopsy and examining it with a microscope.
- Signs of lung rejection include cough, shortness of breath, fever, elevated white blood cell count, and a feeling of not getting enough oxygen.
- After a lung transplant, doctors may need to check the lung tissue by using a long flexible tube with a tiny camera on end (bronchoscopy).
- If you have any signs of rejecting the transplanted organ, you will be given powerful immunosuppressive medications to stop the rejection.
Rejection of the transplanted organ can also occur months or years later.
- Rejection occurring months or years later, and that results in permanent changes in the transplant are called chronic rejection. Signs are similar to those of acute rejection but are often slow to develop.
- Chronic lung rejection usually occurs because of fibrosis (scarring) of the smaller airways and blockages. This process is sometimes called bronchiolitis obliterans syndrome and can be very serious.
- Treatment includes altering the immunosuppressive medications or retransplantation.
- Chronic rejection of the heart occurs because of development of blockage of the coronary arteries in the transplanted heart. Unfortunately, the cause remains unknown, and retransplantation is the only solution. Patients will have all symptoms of heart failure. With a lack of organ donors, retransplantation is not shared.
- Some transplant specialists believe that chronic rejection is a long-term complication brought on by acute rejection. For this reason, contact with the transplantation team about any new symptoms is significant.
In 2012, at 28 years old, Emily Bennett Taylor was diagnosed with stage 4 adenocarcinoma lung cancer. This is the most common type of lung cancer that develops in people who don’t smoke. In most cases of stage 4 disease, the chances of survival are slim. Treatment is usually palliative care, which focuses on managing uncomfortable symptoms instead of curing the condition. But Emily’s tumour shrank enough during chemotherapy treatments that her doctors recommended a pneumonectomy or surgical removal of the lung.
During the procedure, they removed her right lung, part of her right diaphragm, and the lymph nodes down the centre of her chest. They also removed part of the pericardial sac (a two-layer sac around the heart that anchors the core in place, prevents it from overfilling with blood, and provides lubrication to avoid friction as it beats) and rebuilt it with a Gore-Tex material. Emily knew her life would be different after her surgery, but she wasn’t sure how different. There’s a scar that runs from her right breast to the right side of her rib cage as a result of the doctor “split[ting] her in half.”
The surgeon told Emily stories of pneumonectomy patients who were able to bike for 10 miles a day. But she had also heard less optimistic stories. “I knew people who had only a lobe out, and they needed oxygen every time they got on an aeroplane,” she said.
Risks and dangers
Although it is possible to live without a lung, there are a few risks involved. A study in the Journal of Cancer notes that pneumonectomy, or the surgery to remove one of the lungs, is a high-risk surgery that can lead to complications and even death.
Possible complications associated with pneumonectomy include:
- respiratory failure
- excessive bleeding and shock
- abnormal heart rhythms, or arrhythmia
- reduced blood flow
- blood clots in the lung, or pulmonary embolism
The anesthetic from the surgery also carries its own risks. The actual pneumectomy process involves making an incision in the side of the body to remove the affected lung.
The space left after removing the lung will fill with air. During recovery, a person may feel temporary abdominal pain or pressure as this air shifts and assimilates into the body. Over time, the other lung will expand a bit to take up some of this space. The space left will naturally fill with fluid.
After a successful surgery, a person will still take a while to recover. Full recovery without complications may take weeks or even months. While recovering and even after, the person will need to be aware of their limitations and may have to reduce their activity levels significantly.
Some things may cause a person to feel more winded and could put them at risk of reduced blood flow or fainting. Even everyday activities — such as getting out of bed in the morning, standing up from a prone position, or walking up stairs — may cause the person to feel very winded.
Additional factors will also play into a person’s risk. For instance, their general health before the surgery, their age, and any other health conditions they have may affect their individual chances. People with a history of smoking or other lung conditions that limit their lung function will need to be extra careful. They may need additional assistance during recovery and should work closely with a doctor to understand their risks.
Missing a giant vital organ isn’t the only adjustment for Emily. Most people don’t notice she may have a disability unless she’s in a bathing suit and they can see the scar on her back. “I look normal; people expect me to act normally,” she says. Sometimes, she struggles with deciding when, if ever, to tell someone about her disability. “When do you tell people, ‘Oh, I’m struggling with this flight of stairs. Please just pass me because I’ve only got one lung.'” Before her diagnosis, she would have considered herself too strong to need help. Now when Emily goes to the grocery store, she has someone help push her cart out and load her groceries into her car.
This is not to suggest that there aren’t barriers to overcome following lung cancer surgery. According to research from the Division of Thoracic Surgery at St. James University Hospital in England, people who received multiple treatments (including surgery, chemotherapy, and radiation) had far worse breathing problems than those who had surgery alone. This doesn’t mean, of course, that you can opt-out of specific vital treatments, but it does suggest that extra care needs to be taken to ensure the lung function you have is retained. This would typically involve weight loss, physiotherapy, a structured fitness program, and (unsurprisingly) the avoidance of smoke and secondhand smoke.
Chronic pain after lung cancer surgery, often called post-thoracotomy pain syndrome or postpneumonectomy syndrome can be a significant problem as well, interfering with a healthy life in about 50% of people who have had lung surgery.3 Fortunately, this is a very active area of research looking not only at ways to reduce pain (such as using minimally invasive procedures such as VATS) but better ways of helping people cope with and relieve the discomfort.
What to Expect After Surgery
Recovery from lung surgery is different for everyone. It depends mostly on the type of cancer involved, the stage of the disease, and the operation used. Among the most common surgical procedures:
- Wedge resection in which a wedge of tissue is removed from a lung
- Lobectomy in which one (or more) of the three lobes of your lung is removed
- Pneumonectomy in which an entire lung is removed
- Sleeve resection in which malignancy is removed from the airways
Following lung surgery, you would be taken to the intensive care unit (ICU) and then moved to a regular hospital room once your breathing is stabilized. Hospital stays are usually between five and seven days but maybe as long as 10 for a pneumonectomy.
Once discharged from the hospital, most people will take at least two months off to recuperate. Post-surgical rehabilitation would focus on improving your aerobic function with no less than 30 minutes per day dedicated to walking.
As part of your recovery, a pulmonary rehabilitation program would provide structured breathing exercises, nutritional counselling, aerobic and weight training instruction, stress reduction training, and psychotherapy to help you better cope with recovery. The program would be gradually rolled out as you improve with more strenuous activities, like weight training, delayed for at least four to six weeks following your discharge.
Equally important to your recovery are regular visits with your doctor. If you are given the “all clear” and are officially in remission, you would need to have blood tests and computed tomography (CT) scan done every six to 12 months for the first two years4. In some cases, your doctor may request that you come in more frequently.
If everything is still okay after two years, you would likely need to only come in once yearly for repeat blood tests and a CT scan.
Appreciating new life
Celebrating milestones has been a massive part of Emily’s treatment and recovery process. The day before her surgery in New York, Emily and her husband celebrated what her husband dubbed “Lung Day.” Lung Day was full of activities that could quickly be done with two lungs. Their goal was to do it again next year when Emily only had one lung.
She blew up a balloon and blew out birthday candles. They went dancing in Central Park. She went to the top of the empire state building and screamed, “I’m NED!” . “I wasn’t at the time,” Emily said, “but it was our huge goal.”