Lobectomy
What is it?
A lobectomy is an operation done under general anesthesia during
which an entire lobe of the lung is removed.
The lungs are divided into lobes. The right lung has three lobes:
upper, middle, and lower. The left lung has two lobes: the upper
and lower. For example, during a left upper lobectomy, the upper
lobe of the left lung is removed.
What is it used for?
A lobectomy is most commonly used to remove a lung cancer. However,
other indications for lobectomy include fungal infections, infected
cavities in the lung, localized bleeding from the lung, lung abscess,
pulmonary infarction, and other more rare indications.
An entire lobe of the lung is usually removed when treating a
relatively small lung cancer. The entire lobe is removed in order
to remove not only the cancer itself, but also the surrounding
lymph nodes.
Lymph nodes are the body’s filters, a line of defense, against
the spread of the lung cancer. The lymph nodes will trap cancer
cells that are attempting to spread from the cancer through the
lymphatic system. When trapped within the lymph node, some cancer
cells are killed by the lymph node. However, some cancer cells
will survive and begin to grow and divide within the node. Therefore,
the nodes need to be removed with the cancer itself in order to
obtain a cure.
These lymph nodes are located distant from the cancer, usually
along the airways (bronchi.) In order to cure the patient of lung
cancer surgically, all the cancer cells in the lung must be removed.
Therefore, both the cancer and the surrounding lung tissue containing
the lymph nodes are removed.
How is it done?
A lobectomy is performed using an operation called a thoracotomy.
A thoracotomy is an operation used to gain access to the chest
cavity in order to do larger, or more complex operations. The
thoracotomy involves an incision approximately four to six inches
long, located beneath the armpit, or behind the shoulder blade
(scapula.) An opening is created between the ribs in order to
allow the surgeon to see well inside the chest, and to use special
instruments inside the chest.
The lobes of the lung are natural divisions of the lung. Each
lobe has its own pulmonary artery (blood supply), pulmonary vein
(blood drainage), bronchi (airways), and bronchial arteries (blood
supply for the airways.) During surgery, the surgeon identifies
the individual branches of each artery, vein, and bronchus to
the respective lobe. Once these important structures are identified,
they are ligated (tied off) and divided (cut.) The lobe containing
the cancer is then dissected (cut) away from the other lobes,
and is removed.
If performing the lobectomy for cancer, in addition to the lobectomy
the surgeon removes lymph nodes from other areas inside the chest
to assist in staging the lung cancer. The stage of the lung cancer
is the extent of spread of the cancer, and is important in determining
the need for future chemotherapy or radiation therapy.
After the lobe is removed, there is some empty space inside the
chest. That empty space is eliminated naturally by the body. How
does that happen? The remaining lobe(s) on that side expand slightly,
the diaphragm muscle moves upward, and the mediastinum (center
of the chest) moves over to help fill the space. In addition,
the surgeon will leave one or two chest tubes (drains) in the
chest for several days. These drains assist in removing any extra
air, and any extra fluid, that accumulates in the chest after
the lobectomy. Chest X-rays are done daily for several days after
surgery to monitor the condition of the remaining lung.
What are the risks?
Risks include the usual risks of surgery including bleeding, possible
transfusion (rare), infection, pneumonia, prolonged use of mechanical
ventilation (breathing machine), prolonged air leak, heart attack,
and stroke. The risks of a lobectomy increase with age, with poor
lung function, with poor oxygen diffusion, and with related diseases.
Current smokers are at higher risk for pneumonia. Patients with
heart disease, liver disease, kidney disease, and previous stroke
are at higher risk.
What is the recovery?
Most patients spend one night in the intensive care unit. Then,
the patient is transferred to a normal hospital room with cardiac
monitoring. Most patients remain in the hospital for five to seven
days. After discharge from the hospital, we ask that the patient
walk around their house and the yard for the first week, around
the block daily for the second week (equivalent of a quarter mile),
and up to a mile a day by the end of the third week.
The most important things a patient can do to speed recovery are
to use the incentive spirometer, and to get up and walk several
times a day. The incentive spirometer helps prevent fever and
pneumonia. The walking helps to completely open up the lungs,
prevent pneumonia, and prevent blood clots in the legs.
Pain control is very important. If the patient does not have adequate
pain control, he or she will not get up and walk as much as necessary.
We encourage the patient to consent to placement of an epidural
catheter for pain relief while in the hospital after surgery.
We transition patients from the epidural to a PCA (Patient Controlled
Analgesia) pump, which allows patients to administer their own
pain medicine on demand.
At the time of discharge, the patient will have adequate pain
control by use of pain pills.What is the follow-up?
When should the practice be called?
Our practice routinely sees the post-operative patient two to
three weeks after surgery, depending upon the individual circumstances.
The practice is available by telephone 24 hours a day for emergency
needs. The patient or family should call our office for fever
greater than 101.5 degrees Fahrenheit, nausea and vomiting, redness
around the wound, significant drainage from the wound, or other
problems related to the surgery.