Lobectomy

Following a lung cancer diagnosis, the care team develops a lung cancer treatment plan based on the patient’s specific type and stage of disease. One treatment that may be considered for some patients is a lobectomy.

What is a lobectomy?

A lung lobectomy is a surgical procedure to remove a lobe of the patient's lung. A lobectomy may be needed if the patient has been diagnosed with lung cancer, or if he or she has an infection, a benign lung growth or chronic obstructive pulmonary disease (COPD).

Surgery to treat lung cancer is usually done for a type called non-small cell lung cancer (NSCLC). For any type of lung cancer, surgery is usually recommended if the lung cancer stage suggests surgery may be able to remove all of the cancer. The stage of cancer refers to the size and how far it’s spread. Lung cancer that may be completely removed with surgery is called resectable cancer.

What are the risks of a lobectomy?

Because a lobectomy is a major type of surgery, serious side effects are possible. The most common risk is an air leak from the inside of the lung to the chest cavity surrounding the lung. This complication is treated by leaving a tube in the chest cavity to allow air to leak out while the lung heals.

Other complications may include:

• Prolonged air leak
• Reactions to anesthesia
• Lung infection (pneumonia)
• Collapsed lung
• Bleeding
• Pleural effusion (fluid that collects between the lung and chest wall)
• Heart complications, such as irregular heartbeat or a heart attack
• Post-thoracotomy pain syndrome (PTPS, or pain that continues after recovery)
• Pulmonary embolism (blood clot that forms in a leg vein or elsewhere, breaks loose and travels to the lungs)

How to prepare for a lobectomy

It's a good idea to learn as much as possible about the surgery, why it’s the recommended option, the expected results and possible complications. In addition:

• If the patient smokes, it's a good idea to try and stop smoking at least three weeks before surgery. This may help the lung heal and reduce the risk of pneumonia.
• Arrange for someone to drive home and stay with the patient during the first week after surgery.
• Eat a healthy diet with plenty of protein before surgery.
• Do not ingest food and liquids after midnight prior to surgery.
• Ask the care team whether to take any regular medications with a sip of water on the morning of surgery.
• Pack a bag for several days at the hospital.

Pre-lobectomy tests

If a patient is having surgery for lung cancer, he or she may need to undergo imaging tests of the brain and body to make sure the cancer hasn’t spread outside the lung. Breathing tests called pulmonary function tests (PFTs) are usually performed to check whether the other lobes of the lungs may breathe well enough after lobectomy.

The patient may be asked not to eat and drink after midnight prior to surgery. He or she may also learn and practice exercises to help improve breathing. These may include exercises for deep breathing and coughing to facilitate recovery after surgery.

What happens during lobectomy surgery?

Surgeons perform a lobectomy in two main ways. The most common is by making an incision between the ribs, spreading the ribs, and removing the lung lobe through the open incision. This is called a thoracotomy.

Another option for lung cancer that is small or close to the outside of the lung is a procedure involving video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery. During this procedure, the surgeon makes a few small incisions and inserts a scope with a camera between the ribs. Surgical instruments are inserted through the other incisions to remove the lobe. The surgeon views the patient's lung on a video screen.

In general, during a lobectomy:

• The patient meets with an anesthesiologist.
• An intravenous (IV) line is started in the patient's arm.
• The patient receives medication through the IV to make him or her feel relaxed and sleepy, called sedation.
• The patient is taken to the operating room.
• General anesthesia is administered through the IV.
• A breathing tube is inserted to ensure the patient gets enough oxygen during general anesthesia.
• The anesthesiologist monitors the patient's heart rate, breathing, blood pressure and oxygen level during the procedure.
• The thoracotomy incision or VATS incisions are made, and the lobe is removed. Lymph nodes near the lung may also be removed.
• A chest tube is placed to collect fluid and air during recovery.
• The surgeon closes the incision (or incisions), and a surgical dressing is applied.

Lobectomy recovery

Most patients remain in the hospital for two to four days. During the stay, the patient may be given medicine to control pain and be asked to get out of bed to walk frequently.

The chest tube that collects fluid and air during recovery is typically removed after two days. The patient may undergo several chest X-rays to make sure the lung is healing properly. In addition to walking, which reduces the risk of leg blood clots, the patient may be asked to do deep breathing and coughing exercises to prevent pneumonia.

When the patient has recovered enough to go home, he or she may be given pain medications and instructions on how to care for the surgical site. The patient may feel tired, but it’s important to walk frequently. Take medication only as directed by the surgeon, and continue doing the deep breathing and coughing exercises.

Home-care instructions may include watching for particular side effects and complications. Call the care team if any of the following occur:

• Chills or fever
• Pain that isn’t controlled by pain medication
• Shortness of breath
• Redness, warmth, tenderness or drainage at an incision site
• Thick and discolored or blood-tinged phlegm
• Inability to have bowel movements within five days of surgery

Full recovery from lung cancer surgery may take several weeks.

At the patient's first follow-up visit, the surgeon may discuss the results of the procedure and what they mean for future care.