Right Radical Pneumonectomy

Right pneumonectomy should only be performed when a lesser resection will not clear the pathological process. The commonest such indication in the western world is carcinoma of the bronchus. The tumour and involved lymph nodes must be confined to the lung, and lines of resection through vessels and bronchus should be clear of tumour. Radical pneumonectomy permits en bloc resection of the tumour with the superior mediastinal lymph nodes. The right lung is the larger of the two, and careful assessment of respiratory function is necessary pre-operatively. All patients should be instructed pre-operatively in the physiotherapy manoeuvres which will be undertaken post-operatively. When undertaken for pulmonary sepsis, pre-operative physiotherapy may produce a temporary but important improvement in the patient’s condition and help minimise post-operative sputum difficulties. Prophylactic antibiotics commenced with the premedication and continued for 24 h have been shown to reduce the incidence of wound infection but will have no influence on the more serious problems of chest infection and infection of the pleural space.