Lung resection is a surgical procedure to remove all or a portion of a diseased lung. There are several reasons for this surgical intervention, but the most common is as a treatment for lung cancer. When lung resection is performed in the presence of early-stage lung cancer, the prognosis is much better than if the disease has progressed. The type of lung resection performed depends on the severity of the condition.
Reasons for Lung Resection
Although lung resection is often performed on patients with lung cancer, other common reasons for surgical resection of a lung include:
- Congenital lung malformation in children
- Benign growths in the lung
- Infectious lung lesions
- Tuberculosis
- Atelectasis (partial collapse of the lung)
- Emphysema
The majority of lung cancers in adults, 85 to 90 percent, are attributable to smoking tobacco. Other factors that may cause patients to develop lung cancer are secondhand smoke, predisposing genetic factors, air pollution and exposure to asbestos and radon gas.
Types of Lung Resection
Lung resections, like many other operations traditionally performed as open surgery, are now often performed using minimally invasive laparoscopic techniques. Video-assisted thoracoscopic surgery, or VATS, provides several advantages over open surgery, including smaller incisions, less pain and scarring, shorter hospital stays, less risk of infection, and a shorter recovery period. There are several types of lung resection which may be done laparoscopically or as open surgery, including:
Lobectomy
A lobectomy is a surgical procedure in which one lobe of the lung is removed, usually to excise a cancerous tumor. If it is necessary to remove two lobes of the lung, the procedure is called a bilobectomy.
Sleeve Lobectomy
During a sleeve lobectomy, the part of the bronchial tube that attaches to the diseased lobe of the lung is also removed. In this procedure, the resectioning involves reattaching the remaining lobe or lobes of the lung to the remaining segment of the bronchial tube.
Wedge Resection
A wedge resection is the surgical removal of a small, wedge-shaped portion of the lung containing the malignant tissue. In this procedure, some healthy surrounding tissue is also removed for diagnostic testing. This surgery is performed to remove a small tumor or to diagnose lung cancer. A wedge resection can be performed by minimally invasive video-assisted thoracoscopic surgery, VATS, or as a thoracotomy, an open chest surgery.
Segment Resection or Segmentectomy
During a segment resection of the lung, the surgeon does not remove the entire lobe, but does remove a larger portion of the lobe than during a wedge resection.
Pneumonectomy
A pneumonectomy is the removal of the whole lung.
Risks of Lung Resection
All surgery involves some risks, which may include:
- Excessive bleeding
- Blood clots
- Adverse reactions to anesthesia or medications
- Post-surgical infection
- Damage to adjacent organs
- Breathing problems
- Hernia at the incision site
Beyond general surgical risks, lung resection is associated with other, more specific, risks. While rare, these may include:
- Residual air leakage from the lung
- Damaged blood vessels or nerves in the chest
- Ongoing post-surgical chest pain.
Recovery from Lung Resection
Length of recovery from lung resection depends on the patient's overall physical condition before the surgery and which type of surgery was performed. The usual hospital stay, if there are no complications, is about a week to 10 days. There are several aspects to recovery, both in the hospital and at home, which include:
Pain Management
Because lung resection involves incisions into the chest, the spreading apart of the ribs and the possible removal of a small portion of a rib, the patient will experience pain for weeks to months after surgery. Pain medication will be prescribed immediately after surgery and may be continued and then tapered down during the following weeks. Depending on the type of surgery performed, the pain may persist and the patient may require medication for a few months.
Chest-tube Placement
After lung resection, one or more chest tubes are used to drain fluid and blood from the chest cavity. These tubes help the lungs inflate. The tubes are attached to a suction machine that helps fluids to drain and measures the amount of drainage. Once there is no air leaking from the incision site and the affected lung is fully expanded, the drainage tubes will be removed. This usually occurs within 2 to 3 days after surgery. In some cases, air leakage may persist for a period of weeks and the chest tubes will have to remain in place longer.
Respiratory Treatment
In order for the patient to regain as much lung function as possible after surgery, a respiratory therapist will be involved in treatment. Medications may be used to open airways and the patient will be taught to practice deep breathing. Deep breathing is very important in order to expand the affected lung and to prevent pneumonia and other infections. Deep breathing treatments involve the use of a spirometer, a machine to measure the expansion of the lungs during inhalation. In some cases, patients may require oxygen therapy after lung resection.
For 6 to 8 weeks after lung resection, patients are usually advised to restrict physical exercise and heavy lifting. They are, however, encouraged to walk and engage in light physical activity as soon as possible.
