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Lobectomies & Pneumonectomies

Lobectomy:

Introduction

Lung cancer is one of the leading causes of cancer deaths. You have a better chance of surviving a lung cancer when your disease is detected in its early stage (stage I) and you undergo a procedure known as lobectomy. Lobectomy is a surgical procedure to remove one of the lobes of the lungs where your affected tissues or tumor are located. Previously, lobectomy used to be performed with an open procedure known as thoracotomy, where your surgeon would make an incision in your chest and spread your ribs apart in order to gain access into your chest cavity and remove your affected tissues. This necessitated a bigger incision and resulted in a longer hospitalization and recovery period.

VATS Lobectomy

Video-assisted thoracic surgery (VATS) lobectomy is a minimally invasive procedure, where your surgeon would make three 1-inch incisions and one 4-inch incision in order to gain access into your chest cavity without spreading your ribs.

During this procedure, your surgeon will insert a long slender tube fitted with a video camera (thoracoscope) and other surgical instruments through the previously placed small incisions. The video camera relays images of your chest cavity/operative site onto a monitor, which guides your surgeon to maneuver the surgical instruments and resect the affected tissues/tumor of your lungs through the small incisions.

Indications

A VATS lobectomy procedure is indicated in:

  • Patients with stage I non-small cell lung cancer (a primary tumor that has not spread beyond the lungs and is under 3 cm)
  • Patients who have a single enlarging pulmonary nodule
  • Patients who need diagnostic or therapeutic procedures performed on the outer area of the lung

Advantages of VATS Lobectomy

  • Patients usually experience less pain and have a quicker recovery compared to traditional thoracic surgery technique.
  • There is a reduced risk of bleeding and infection as the procedure requires comparatively smaller incisions.

Risks

Some of the possible risks associated with a VATS lobectomy procedure include bleeding, infection, anesthesia complications, air leak in your lungs that does not heal, damage to the adjoining tissues, accumulation of pus in your chest cavity (empyema), and ongoing pain in your chest wall.

Recovery

  • Your thoracic surgery team will help you recover from your VATS procedure as quickly as possible
  • You will be hospitalized for three to four days following your surgery
  • You will be given pain medications to control your pain
  • You will be instructed on your diet, activity restrictions, and wound care
  • You may return to work in four or six weeks after your surgery
  • You can resume more strenuous activities six to twelve weeks after your surgery
  • You will be recommended a follow-up appointment seven to ten days after your surgery and your progress will be monitored with chest x-rays and wound site assessment

Pneumonectomy:

A pneumonectomy refers to the surgical removal of the entire lung to treat lung cancer. There are two types of pneumonectomy:

  • Standard pneumonectomy: removal of the entire lung
  • Extrapleural pneumonectomy: removal of the entire lung, along with a portion of the diaphragm and the linings of the lung (pleura) and heart (pericardium) on the affected side. Extrapleural pneumonectomy is used to treat mesothelioma, a cancer that affects the linings of the lungs.

Indications

Pneumonectomy is usually performed to treat cancers that are

  • Large
  • Affect more than one lobe of the same lung
  • Is located near the center of the lung
  • Affects a large section of the pulmonary vein or artery (blood vessels connecting the lungs to the heart)

Pneumonectomy may also be performed to treat traumatic chest injuries and chronic obstructive pulmonary disease (COPD) that causes airway obstruction.

Procedure

Pneumonectomy is performed under general anesthesia. An endotracheal tube is inserted into your mouth through the windpipe to facilitate breathing during the surgery. Your surgeon makes an incision on your chest on the side of the diseased lung, along the ribs. The ribs are separated and a portion of the rib may be removed to provide a better view and access to the diseased lung. The lung is then collapsed. The major blood vessels and the main air tube (bronchus) of the lung are clamped and tied off. The cut end of the bronchus is closed with stitches or staples. The diseased lung is now removed from the chest cavity. The bronchus and blood vessels are checked for leakage of air and bleeding. Your surgeon then closes the incision in the chest wall with surgical sutures.

Post-operative care and recovery

Following surgery, you will have an intravenous (IV) line to provide fluids and pain relieving medicines. The ventilator is removed and you will be asked to cough in order to clear the airways. You will also be taught breathing exercises to prevent infection and inflammation. You will be required to stay in the hospital for 7-10 days. After discharge, you are advised against driving for a week, lifting heavy weights and other strenuous activities. Breathing exercises and mild physical activity like walking are encouraged for better blood circulation and muscle strength. You can get back to work in about eight weeks. Call your doctor immediately in case you develop the following symptoms after pneumonectomy:

  • Shortness of breath or difficulty breathing
  • Increased redness, pain, drainage or swelling around the incision site
  • Chest pain
  • Fever

Risks and complications

As with all surgical procedures, pneumonectomy may be associated with complications, including:

  • Infection
  • Pain at the incision site and the region where the ribs were cut
  • Pneumonia (infection in the lungs)
  • Excessive bleeding
  • Bronchopleural fistula (an abnormal passageway that develops between the cut bronchus and the space between the layers of pleura)
  • Heart attack or abnormal heart rhythms
  • Stroke
  • Blood clots in the legs that may travel to the lungs
  • Empyema (pus in the pleura)
  • Pulmonary edema (fluid accumulation in the lungs)
  • Postpneumonectomy syndrome (shifting of the organs in the chest cavity towards the vacant space left by the excised lung)
  • Shortness of breath
  • Kidney failure

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