Fundamentals of standard left and right pneumonectomy

Until a few decades ago, pneumonectomy was the standard of care for resection of non-small cell lung cancer. Because of pneumonectomy higher morbidity and mortality rates, surgeons are nowadays determined to perform lobectomies whenever possible. However, pneumonectomy remains the only surgical option in patients for whom a lobar resection is not technically or oncologically possible, even considering bronchoplastic and/or angioplastic procedures. Close attention is needed in preoperative course and during intraoperative assessment to maintain the indication of pneumonectomy, considering the possibility of a lobar resection, and ruling out a metastatic or non-resectable patient. This paper describes the casual approach for standard left or right pneumonectomy including technical consideration, to achieve safe and complete resection leading to adequate oncological outcomes in lung cancer surgery.