Lobectomy

What is a lobectomy?

A lung lobectomy (pulmonary lobectomy) is a surgery to remove a section (lobe) of your lung. This is a common surgery for treating non-small cell lung cancer in its early stages. It also treats lung carcinoid tumors and small cell lung cancer.

A surgeon may also do a partial lobectomy, a segmentectomy. This means they remove part of a lobe.

Besides lung cancer, other reasons for a lobectomy include:

• Problems with how your lung formed before birth
• Damage to your lung from infection or radiation
• Tumors that have spread from other places in your body to your lungs
• Bleeding from lung damage

Surgeons don’t open your chest for most lung resections. Instead, they use a minimally invasive method like video-assisted thoracoscopic surgery (VATS) or robot-assisted thoracoscopic surgery (RATS). In both types, surgeons use tools they pass between your ribs through small cuts in your chest. This way, they don’t need to break or spread your ribs.

For a more complex lung surgery, a surgeon uses a thoracotomy. This involves making a larger cut and spreading your ribs apart to reach your lung.

How should I prepare for a lobectomy?

Before lobectomy surgery, you’ll have tests, like:

• A physical exam
• Imaging like a chest X-ray, CT scan or PET scan
• Procedure to look between your lungs (mediastinoscopy)
• Breathing tests (pulmonary function tests) and six-minute walk tests
• Perfusion scan to measure air and blood flow in your lungs
• Biopsy of lung tissue or lymph nodes using a needle or bronchoscopy
• Blood tests
• Heart tests like an electrocardiogram, echocardiogram or exercise stress test

If you have lung cancer, your provider will want to know if cancer cells have spread to other parts of your body. This is staging, and it helps your team plan your treatment. In some cases, a provider may do a CT scan or MRI of your head. This can show if cancer has spread to your brain.

A heart expert (cardiologist) may evaluate you if you’ve had heart issues. This helps with estimating risk and planning your surgery. Also, you’ll meet with an anesthesiologist who will discuss pain control during and after your surgery.

Avoiding the use of tobacco products before surgery can make you less likely to have complications.

A provider will tell you in advance what time to stop eating and drinking the night before your surgery.

What happens during a lung lobectomy?

During your lobectomy surgery, you’ll be asleep and won’t feel any pain. This is because of the anesthesia you’ll receive. A ventilator will manage your breathing through a tube in your throat. You’ll have an IV in your arm so you can receive medicine through it.

Your surgeon will follow these steps:

1. Make a cut on the side of your chest between your ribs. (For a VATS or RATS procedure, make several small cuts in your chest for access without spreading your ribs.)
2. Place a small video camera and surgical tools through the cuts. Your provider operates using the large image of your lung on screens.
3. Perform a biopsy if you didn’t get a diagnosis yet. A lab will analyze the sample.
4. Remove the lobe by dividing the branches of the blood vessels and airway going into that part of your lung. They’ll preserve the vessels and airway to your remaining lung.
5. Remove the sample using a special bag to pull the tissue through one of the small cuts.
6. Check to be sure they took out enough tissue around the tumor to be sure they got it all.
7. Sample the lymph nodes in your chest to check for cancer spread.
8. Check to make sure that nothing is bleeding.
9. Rinse out your chest cavity.
10. Perform injections in your chest wall to reduce pain after surgery.
11. Close your cuts with staples or sutures (stitches).

How long does this procedure take?

The median time for a pulmonary lobectomy is about two hours. That means half of the surgeries take less than that, and half of them take longer.

What are the potential benefits and risks of a lobectomy?

A lung surgery offers the best chance of a cure for people with early-stage lung cancer. A segmentectomy or lobectomy can cure cancer in people with stage I to III non-small cell lung cancer. Results of a less invasive lobectomy are as good as (or better than) those of an open procedure.

The most common complication is an irregular heart rhythm, atrial fibrillation.

Other possible risks of a pulmonary lobectomy may include:

• Bleeding that requires your surgeon to open your chest or give you blood
• Air leak from your lung that lasts longer than five days
• Blood clots in your legs
• Nerve injury that can affect your diaphragm or voice function
• Air or gas in tissues under your skin
• Infection
• Shortness of breath when you exert yourself, if you also have bronchitis or emphysema

What happens after a lobectomy?

After your lobectomy surgery, here’s what happens:

• A provider will stop the medicine that keeps you asleep.
• You’ll go to a recovery unit and receive medicine for the pain.
• When you’re awake enough, your healthcare team will remove your breathing tube. Most people don’t remember this.
• You’ll go to a recovery room (most common) or intensive care unit (ICU). You’ll move from a recovery room to a regular room after you recover from anesthesia.
• You’ll have one or two drains in your chest to remove extra fluid and air from around your lung. A healthcare provider will remove the drains when there isn’t much coming out anymore.
• Your care team will encourage you to cough regularly and do breathing exercises. This will require good pain management.
• Your providers will monitor you for irregular heartbeats.
• You’ll receive blood thinners to prevent blood clots in your legs while you’re in bed. You may also have compression devices on your legs for this reason.
• Your providers will help you walk the day after surgery.

How long does it take to recover from a lobectomy?

With a VATS or RATS lobectomy, your hospital stay is typically two to three days. Recovery tends to be faster due to less pain and bleeding with VATS or RATS compared to an open-chest procedure. This means a faster return to work and regular activities.

Lobectomy recovery after an open-chest surgery typically requires three to four days in the hospital.

When you go home after VATS or RATS, you’ll have a one-week supply of strong pain medication. Most people don’t need a refill. When you leave the hospital, you should be able to care for yourself. But it’s good to have someone nearby who can help you if you need it as you recover.

You may receive oxygen therapy after your hospital stay. Most people will need this for a brief time while they recover from surgery.

After a VATS or RATS, you can drive again once you stop taking strong pain medicine. In general, you may be able to return to work at a desk around two weeks after going home. You should take four weeks to recover for jobs that require lifting.

When should I call my healthcare provider?

Contact your provider if you have signs of infection, like a fever, chills and fatigue.

You’ll have a follow-up visit seven to 21 days after your surgery. Your provider can talk with you about your test results then. You’ll have a chest X-ray, and your surgeon will assess your wounds and your recovery. Also, they’ll give you more guidelines about your activities, return to work and what to eat.

Depending on the cancer stage, your provider may refer you to an oncologist. For any stage, you can expect to have CT scans for the next five years. You may worry about lung cancer coming back. This is why your provider will schedule a CT scan every six months after your surgery.

Is a lobectomy major surgery?

Yes, a lobectomy is a major surgery. Some side effects can be serious. Your lungs contain large and fragile blood vessels that can bleed.

Is lobectomy dangerous?

It can be. Death after lung surgery is quite rare. In most cases, a problem with your lungs or airways is the cause. These risks are lower in some healthcare facilities than others. This is why it’s better to choose one that performs a lot of lobectomies. It’s important to ask about these risks during your preoperative visits.

What is the life expectancy after a lobectomy?

Long-term survival after a lobectomy for lung cancer depends on the stage of the tumor. The stage is in the surgical pathology report.

It’s possible to have a lung cancer recurrence after a lobectomy. This means the cancer comes back. If it happens, it’s usually in the first five years after surgery. Your provider considers you cured of cancer if you have no evidence of it five years later.