Sleeve lobectomy (pulmonary sleeve resection)

This page was reviewed under our medical and editorial policy by

Peter Baik, DO, Thoracic Surgeon

This page was updated on September 25, 2022.

A sleeve lobectomy, or pulmonary sleeve resection, is a surgical procedure to extract a tumor from the lung without having to perform a pneumonectomy (removal of the entire lung on one side of the chest) or two lobes of the lung. After the tumor’s removal, the remaining tissue above and below the tumor are reconnected (sewn back together).

Why sleeve resection may be done

A sleeve resection is a potential treatment option for non-small cell lung cancer (NSCLC), the most common type of cancer in the lung. Less commonly, it may be used to treat small cell lung cancer (the other main type of lung cancer) or a neuroendocrine tumor in the lung.

Surgery is most often used as the first-line treatment for early-stage lung cancers that haven’t spread beyond the lungs.

Surgeons perform many types of lung cancer operations. The patient and his or her care team determine the most appropriate type of surgery based on the tumor’s location and size, and the patient's lung function and overall health.

A sleeve resection is one of these options, and it’s typically used to treat tumors located within the bronchi—the airways that connect the windpipe to the lungs.

For lung tumors that meet the criteria, sleeve resection may be a beneficial treatment option, potentially allowing patients to retain more lung function than through other lung cancer surgeries.

However, it’s not the most commonly used procedure for lung cancer. For example, a non-small cell tumor contained within one of the five lobes of the lungs is typically treated with a lobectomy (surgery to remove the entire lobe).

A lobectomy is also the most common operation for lung neuroendocrine tumors and small cell lung cancer. Most of the time, though, small cell lung cancer has spread beyond the lungs before it’s diagnosed. Because of this, surgery of any kind is typically not used as a primary treatment option for small cell lung cancer.

Preparing for a pulmonary sleeve resection

Quit smoking. The most crucial step before any lung surgery, including a sleeve resection, is for patients who smoke to quit. Smoking hinders the body's ability to heal wounds and increases the risk of surgical complications. While quitting smoking as early as possible is ideal, smokers are highly encouraged to quit at least four to six weeks before lung surgery. Doing this—and remaining smoke-free for at least four weeks afterward—is estimated to cut the risk of complications related to wound healing in half, according to the American College of Surgeons.

Check on medications or supplements. Before undergoing a sleeve resection, it’s important to inform the care team about any medications or supplements the patient is taking (both prescription and over-the counter) and ask whether any of them should be stopped before or after the surgery.

Seek instructions on eating and drinking before surgery. Patients may be told not to eat or drink anything after midnight on the day of surgery.

The care team may provide more specific instructions on how to prepare for a sleeve resection or other lung cancer surgeries.

Sleeve lobectomy procedure

A sleeve resection is performed while the patient is under general anesthesia, which is administered before the operation through an intravenous (IV) line and by inhaled anesthetic through a breathing tube.

The operation usually starts with the surgeon making an incision (about 3 to 8 inches long) in the chest. However, the incision site and the size of the cut depend on the tumor's location and how the lung surgery is being performed. Then, the surgeon cuts through muscle underneath the skin and moves the ribs slightly to reach the lung. This part of the procedure is called a thoracotomy.

Sometimes, doctors use a less invasive procedure called video-assisted thoracic surgery (VATS). A lighted tube with a camera and surgical tools are inserted through small incisions and used to remove a tumor. A VATS procedure requires smaller cuts and has a lower risk of complications and a potentially faster recovery time.

After the tumor is removed from the lung, as well as some of the surrounding tissue (a margin), the remaining tissues are sewn together.

Surgery may take up to six hours, but ask the surgeon to provide a more precise timeline.

Sleeve lobectomy recovery

Tubes are placed in the chest to drain fluid and air, and they’ll remain until excess fluid and air have ceased to drain from the surgical area (typically within two to five days). The chest tubes ensure that fluid or air leaking from the lungs escapes the body and doesn’t get stuck in the chest. Air leakage suggests that the lungs aren’t able to expand and work properly. Before leaving the hospital, the patient may need to undergo a chest X-ray to check on lung expansion.

Pain at the incision site and the surrounding area is also common after a sleeve resection or other lung cancer surgery. It’s important to communicate any pain with the care team so that it may be properly mitigated.

A hospital stay of about five to seven days is typical after a lung cancer surgery such as a sleeve resection.

It may take weeks or months for patients to resume normal activities after lung cancer surgery. Pain may persist for weeks, especially if a thoracotomy was performed, as this procedure requires separating the ribs. If the sleeve resection was performed using VATS or RATS, the recovery time tends to be shorter.

Benefits, risks and results

If a sleeve resection is a feasible treatment option for a lung tumor, the primary benefit is that it may allow the patient to retain more lung function than other procedures, such as a pneumonectomy (surgery to remove an entire lung).

The patient and his or her care team may carefully weigh the benefits and risks specific to his or her cancer to determine the best surgery to use.

Sleeve lobectomy complications

All lung cancer surgeries may cause complications. The potential risks and side effects of a sleeve resection and other lung cancer surgeries include:

  • Allergic reaction to anesthesia
  • Excessive blood loss
  • Blood clots in the legs or lungs
  • Infections at the incision site
  • Pneumonia
  • Irregular heart rhythm
  • Heart attack

Patients recovering after a sleeve resection should communicate with their care team about any side effects or problems. It’s particularly important to look out for the following symptoms and to call the doctor if they occur. These include:

  • Pain that worsens or persists despite pain medication
  • Constipation lasting four days or more
  • Leg or ankle pain or swelling that’s getting worse
  • Painful urination or other symptoms indicating a urinary tract infection
  • New rash
  • Swelling or drainage at the wound site
  • Fever
  • Signs of pneumonia (fever, nausea, vomiting, coughing, breathing difficulties, chills, chest pain)

Life after a sleeve resection

After a sleeve resection or other lung cancer surgery, it may be difficult to engage in physical activity as before, as patients may struggle to catch their breath. Younger patients whose lungs were healthy besides the cancer tend to bounce back from surgery faster, and may return to physical activities after they recover.

However, many others are physically debilitated after lung cancer surgery. Some studies suggest that about 70 percent of people cannot meet physical activity guidelines three and a half years after lung cancer surgery, according to the Cochrane Database of Systematic Reviews.

Furthermore, a lung cancer diagnosis itself, as well as lung cancer surgery, may lead to an increase in mental health concerns, including anxiety and depression.

Experts recommend that patients continue to exercise after lung cancer surgery, if they're able to do so, to keep their lungs, body and mental health in good shape. Evidence suggests that exercise may help improve recovery and overall quality of life. The care team can share when and how much exercise is safe to perform, but even walking around the house for a couple of minutes may be beneficial.

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