What is a lung lobectomy?

A lung lobectomy is a surgical procedure to remove a lobe of your lung. A lobectomy may be needed if you’re diagnosed with lung cancer, or if you have 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 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

Learn as much as you can about the surgery, why it’s the recommended option, the expected results and possible complications. In addition:

• Try to stop smoking at least three weeks before surgery, if you still smoke. This may help your lung heal and reduce the risk of pneumonia.
• Arrange for someone to drive you home and stay with you 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 your care team where you should take any of your regular medications with a sip of water on the morning of surgery.
• Pack a bag for several days at the hospital.

What happens before surgery?

If you’re having surgery for lung cancer, you may need to undergo imaging tests of your 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 your lungs may breathe well enough after lobectomy.

You may be asked not to eat and drink after midnight prior to surgery. You 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 surgery?

There are two main ways to perform a lobectomy. 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. Other options for lung cancer that is small or close to the outside of the lung are 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 your lung on a video screen.

In general, during a lobectomy:

• You meet with an anesthesiologist.
• An intravenous (IV) line is started in your arm.
• You receive medication through the IV to make you feel relaxed and sleepy, called sedation.
• You’re taken to the operating room.
• General anesthesia is administered through the IV.
• A breathing tube is inserted to ensure you get enough oxygen during general anesthesia.
• The anesthesiologist monitors your 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.

What happens after surgery?

Most patients remain in the hospital for two to four days. During your stay, you 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. You 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, you may be asked to do deep breathing and coughing exercises to prevent pneumonia.

When you’ve recovered enough to go home, you may be given pain medications and instructions on how to care for the surgical site. You may feel tired, but it’s important to walk frequently. Take your medication only as directed by your surgeon, and continue your deep breathing and coughing exercises.

Home-care instructions may include side effects and complications to watch for. Call your care team if you notice:

• 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 your first follow-up visit, your surgeon may discuss the results of the procedure and what they mean for future care.