Lobectomy: Types, Risks, Preparation, Before and After Surgery

Definition:

It is a surgery to remove one of the lobes of the lungs. The lungs have sections called lobes.

The right lung has three lobes. The left lung has two lobes. A lobectomy can be performed when a problem is found in only part of the lung. The affected lobe is removed, and the rest of the healthy lung tissue can function normally.

A lobectomy is performed more frequently during a thoracotomy surgery; during this type of surgery, the chest is opened.

In most cases, during a lobectomy, the cut (incision) is made at the level of the affected lobe. The incision is usually made in the front of the chest below the nipple and wraps around the back below the shoulder blade.

The surgeon has access to the thoracic cavity through the exposed ribs to remove the lobe.

In some cases, a video-assisted thoracoscopic surgery (VATS) is used to perform a lobectomy. This is a less invasive procedure.

 

It shows the internal organs on a screen. Small tools are used through the other incisions to perform the surgery.

Types of lobectomy

Some different methods can remove a lobe of your lung. Your surgeon will recommend one of these according to the characteristics of your cancer in particular and how comfortable it is with each of the procedures:

Open Lobectomy: In an open lobectomy, a lobe of the lungs is removed through a long incision in the side of the chest.

VATS Lobectomy (video-assisted thoracoscopic surgery): In this procedure, a lung lobe is removed through small incisions in the chest with the help of instruments and a camera.

A VATS lobectomy can be considered for stage 1 lung cancer with relatively small tumors (usually less than 3 to 4 cm). When it is possible to perform a lobectomy with VATS, it can cause fewer complications than an open lobectomy.

VATS vs. open lobectomy

How can you and your doctor choose between an open lobectomy and a lobectomy with VATS, and what is the difference in recovery between these procedures?

Studies have found that the recovery period after a VATS lobectomy is often shorter, with less postoperative pain than an open lobectomy.

Post-thoracotomy pain syndrome (also called post-pneumonectomy syndrome) is a condition of persistent chest pain that occurs months or years after lung cancer surgery and seems to affect about 50 percent of people who have these surgeries.

While we do not have studies that examine precisely this concern, the VATS procedure will likely result in much less chronic pain as well.

Despite a faster recovery, there are times when VATS is not possible. The location of some tumors makes it challenging to perform VATS, and, in these cases, open lobectomy may be safer and more likely to remove the entire tumor.

Not all surgeons feel comfortable performing VATS, which could play a role in the decision. Be sure to ask why an open lobectomy is recommended if this is the only option.

You may want to get a second opinion from a surgeon who is comfortable performing VATS, but keep in mind that even the best surgeons will not perform VATS if the location of a tumor suggests that an open lobectomy is the best surgery.

There is some controversy over whether VATS procedures are becoming the standard of care, but much of the concern lies with the surgeons’ experience who perform the procedure.

For early-stage lung cancer, a VATS lobectomy is usually the ideal approach. Still, with locally advanced lung cancers, the surgeon’s experience is likely to be much more critical.

Another reason why a second opinion may be necessary with lung cancer is that studies show that the results of people undergoing lung cancer surgery in centers that perform more significant volumes of these surgeries tend to be better.

The likelihood of a good outcome with lung cancer tends to be better in larger cancer centers and teaching hospitals than in smaller community hospitals.

Why could I need a lobectomy?

A lobectomy can be done when a problem has been found in a lobe. A lobe can be removed to prevent the spread of the disease to the other lobes.

This may be the case with tuberculosis or certain types of lung cancer. Chest and lung health conditions that can be treated with lobectomy include:

Tuberculosis (TB): This continuous (chronic) bacterial infection usually infects the lungs.

Pulmonary abscess: This is an area of ​​pus that can form in the lung. If the spot does not go away with antibiotics, it may be necessary to remove it.

Emphysema: This is a chronic disease caused by the rupture of the elastic fibers in the lungs. This makes it harder for the lungs to move when breathing.

Benign tumor: This is a growth that is not cancer. It can press on large blood vessels and affect the function of other organs.

Lung cancer: This is a type of cancer that can affect the bronchi, one or more lobes of the lungs, the pleural lining, or other lung tissue. If left untreated, it can spread to other parts of the body.

Mycotic infection: Fungi can grow in the body and cause infections.

Your healthcare provider may have other reasons to recommend a lobectomy.

What are the risks?

All procedures have some risks. The risks of this procedure may include:

  • Infection.
  • Air in the space between the lung coverage (pleural space) causes the collapse of the lung (pneumothorax).
  • Bleeding
  • A tube-shaped opening between the airways (bronchi) and the pleural space causes air or fluid to leak into the chest (bronchopleural fistula).
  • An area of ​​pus in the thoracic cavity (empyema).
  • Fluid in the space between the lung and the inner wall of the chest (pleural effusion).

Your risks may vary according to your general health and other factors. Ask your doctor what the most critical chances for you are. Talk to them about any concerns you have.

Preparation

Your doctor will explain the procedure. Ask them any questions you have.

You may be asked to sign a consent form authorizing the procedure. Read the form carefully. Ask questions if something is unclear.

Tell your health care provider if you:

  • Are you pregnant, or think you may be pregnant?
  • He is allergic to iodine.
  • Is sensitive or allergic to any medication, latex, tape, or anesthetic medications (local and general).
  • Take any medication, including prescriptions, over-the-counter medicines, vitamins and herbal supplements.
  • He has had a bleeding disorder.
  • Take anticoagulant medications, aspirin, or other medications that affect blood clotting.

Be sure to:

  • Stop taking certain medications before the procedure, if so directed by your health care provider
  • Do not eat or drink for 8 hours before the system or instructions from your healthcare provider in this regard.
  • Stop smoking.
  • Plan for someone to take you home from the hospital.
  • Follow all other instructions given by your health care provider.

You may have blood tests or other tests or exams before the procedure; your health care provider will tell you more.

What happens during a lobectomy?

  • You will be asked to take off your clothes and be given a hospital gown to wear. You may be asked to remove jewelry or other objects.
  • You will lie on an operating table.
  • An intravenous (IV) line will be placed in your arm or hand.
  • You may be given antibiotics before and after the procedure.
  • You will be given general anesthesia. This medication prevents pain and allows you to sleep during the procedure.
  • A breathing tube will be placed in the throat and connected to a respirator. Your heart rate, blood pressure, and breathing will be observed during the procedure.
  • A soft, flexible tube (catheter) can be placed in your bladder. This is to drain the urine during the procedure.
  • The hair in the area of ​​the surgery can be trimmed. The skin on the site will be cleaned with an antiseptic solution.
  • A cut (incision) will be made in the front of your chest at the lobe level to be removed. The incision will go under your arm around your back.
  • When the ribs can be seen, a unique tool will be used to separate them. The pulmonary lobe will be removed.
  • One or more tubes can be put on your chest. These are to help eliminate air and fluids after surgery.
  • The incision of the skin will be closed with stitches (sutures) or staples. A bandage will be placed in the area.
  • A thin tube (epidural catheter) can be placed in the lower spine area. This is done to send pain medication to your back. It can be done in the operating room or the recovery room.

After the lobectomy

You will be given painkillers if you need them. A chest x-ray can be done immediately after surgery. This is to make sure that your lungs are well. You will stay in the hospital for several days.

You may have one or more chest tubes near the incision to drain air or fluid. Thoracic lines can cause pain when you move, cough, or breathe deeply. They will be taken out before you leave the hospital.

They will teach you deep breathing exercises and coughing methods to help your lungs expand after surgery.

This is to help breathe and prevent pneumonia. You may need oxygen for some time after surgery.

In most cases, oxygen will stop before you go home. Or, you may have to go home with oxygen.

You will be asked to move as much as possible while in bed and walk as soon as possible. This will help your lungs heal faster.

You may be given fluids to drink a few hours after surgery. You will be given food to eat as much as you can.

Before you leave the hospital, you will make an appointment for a follow-up visit with your health care provider. You will go home when your doctor tells you that it is okay. Someone will have to take you home.

At home, keep the incision clean and dry. Your healthcare provider will give you instructions to take a bath. The stitches or staples will be removed during a follow-up appointment.

The incision may be sore for several days. Your chest and shoulder muscles can hurt, especially with deep breathing, coughing, and activity.

You can take painkillers as directed by your health care provider. Aspirin and some other pain relievers may increase bleeding. Be sure to take only medications recommended by your health care provider.

Keep doing the breathing exercises you learned in the hospital. Slowly increase your physical activity as tolerated. It may take several weeks to return to normal.

You may need to avoid lifting heavy objects for several months. This is to prevent tension in the muscles of your chest and the incision.

While you are healing, take steps to avoid exposure to:

  • Infections of the upper respiratory tract, such as cold and flu.
  • Tobacco smoke.
  • Chemical fumes
  • Environmental pollution.

Call your doctor if you have:

  •  The fluid that escapes from the incision.
  • Pain around the incision gets worse.
  • Feeling breathless
  • Difficulty breathing.
  • Pain with breathing
  • Chest pain.
  • Tos.
  • Confusion or other change in mental state.
  • Sputum is green, yellow, or bloody (phlegm).

Your health care provider can give you other instructions after the procedure.