Lung surgery

Anatomy or system affected: Lungs, respiratory system

Definition: The correction and treatment of such lung problems as bronchiectasis, cancer, emphysema, and pneumothorax

Indications and Procedures

Located in the chest (or thoracic) cavity, the lungs rest on the diaphragm. Each lung is connected to the trachea, which brings air in on inspiration and carries it away on expiration. Prior to its entry into the lungs, the trachea forms two bronchi. Each enters a lung near its middle and subdivides into smaller and smaller passages called bronchioles. The smallest tubes open into tiny air sacs called alveoli. Each alveolus contains blood vessels called capillaries that take up oxygen and release carbon dioxide into the lungs to be expelled as waste. Alveoli are arranged into lobules, which are united into lung lobes. The left lung contains two such lobes, and there are three in the larger right lung. Appropriate alveolar function is essential to life. To optimize their action, the lungs are surrounded by a double membrane, the pleura, and supplied by nerves that control expansion on inspiration and contraction on expiration. This size change, accomplished by muscular action, normally occurs eighteen times per minute throughout life. It slows during sleep and accelerates during exercise.

Good health requires adequate lung operation, which can be compromised in many ways. The best-known lung disorders are abscesses, asthma, bronchiectasis, bronchitis, cancer, emphysema, pneumonia, pneumothorax, and tuberculosis. Of these, lung cancer, abscesses, bronchiectasis, and pneumothorax can be corrected surgically.

Lung cancer is a leading cause of cancer death among both men and women. The disease has been attributed primarily to smoking, although causative agents such as asbestos, radioactive substances, and other air pollutants also have been implicated. The development of lung cancer is slow until severe symptoms appear. An early warning is a persistent cough unassociated with asthma or emphysema, chest pain, shortness of breath, fatigue, and general listlessness. The detection of lung cancer in its beginning stages requires regular chest X-rays. Early detection greatly enhances long-term survival.

Lung cancer is best treated by surgery. This requires the removal of a small wedge of lung tissue, a lobectomy (lobe removal), or a pneumonectomy (lung removal), depending on the stage of the cancer. During surgery, general anesthesia is followed by an incision around the rib cage on the affected side, along a lower rib. The rib is then detached to produce a gap, and the tumor and/or section of the lung is removed. Postsurgical patients are kept in an intensive care unit for several days, where they are fed and given therapeutic drugs intravenously. Chest drainage tubes are used to drain the incision site. Convalescence takes several months after leaving the hospital. Complications can include infection at the site of the incision and lung collapse.

Lung abscesses most often result from the inhalation of food or tooth fragments. The symptoms are chills, fever, chest pain, and a severe cough that brings up phlegm containing blood and pus. Abscesses are often located using X-rays. In many cases, antibiotics are curative. Severe and/or large lung abscesses, however, require surgical drainage or—in extreme cases—the surgical removal of affected lung tissue. For lung abscesses to require surgery, the affected tissue must be thick-walled and antibiotic-resistant. The simplest such cases involve the placement of a catheter in the abscess to act as a drain. In very severe cases, the affected lung portion (usually a wedge) is removed surgically, as with lung cancer.

Bronchiectasis, the distortion of air tubes, is often the result of childhood lung infections and takes years to develop. In most cases, it causes the production of large amounts of foul-smelling phlegm and predisposes the patient to repeated severe lung infections following colds. Diagnosis is by X-ray, and treatment is often the use of antibiotics at the first sign of any cold. In some cases, the problem is severe enough to require lung surgery. Bronchiectasis that is severe enough to cause recurrent pneumonia in the same lung segment is treated by surgery when the air tube involved can be removed as well. The potential dangers of this procedure are infection and lung collapse, but they are uncommon.

Pneumothorax occurs when air enters the space between the pleura layers around a lung, causing the afflicted lung parts to collapse. It may be attributable to chest injury (such as knife wounds) or to air from ruptured blisters on the surface of the lungs. The symptoms of pneumothorax are breathlessness, chest pain, and chest tightness. Minor pneumothorax often cures itself, but severe pneumothorax can be fatal if left untreated. Surgery to correct major pneumothorax, although rare, must be carried out quickly. Minor pneumothorax cases that require surgical intervention usually involve the insertion of a catheter to remove the intrapleural air. Patients are then monitored for several days to ensure proper healing. In cases in which the leakage of air persists or a pleural tear is responsible for the pneumothorax, surgical repair of the pleura is required.

Uses and Complications

Lung surgery is straightforward but potentially dangerous because it can lead to death as a result of respiratory failure. After major operations, it is important for patients to convalesce slowly and to comply with the physician’s instructions. It is particularly important for the patient to ensure that infection does not occur, to report pain and other danger signs, and to convalesce carefully. The resumption of work and physical activity should be as directed by a physician.

Treating problems associated with lung surgery includes better diagnosis via computed tomography (CT) scanning and magnetic resonance imaging (MRI). Furthermore, the use of cytotoxic drugs and radiotherapy to treat cancer, including lung cancer, seems to minimize the severity of the surgical treatment of these lesions.

Bibliography

American Cancer Society. Lung Cancer: What You Need to Know—Now. Author, 2013.

Beers, Mark H., et al., eds. The Merck Manual of Diagnosis and Therapy. 20th ed. Merck Research Laboratories, 2018.

Griffith, H. Winter. Complete Guide to Symptoms, Illness, and Surgery. 6th ed. Perigee, 2012.

Matthews, Dawn D. Lung Disorders Sourcebook. Omnigraphics, 2002.

"Lung Surgery." MedlinePlus, www.nlm.nih.gov/medlineplus/ency/article/002956.htm. Accessed 20 July 2023.

Papadakis Maxine A. et al. Current Medical Diagnosis and Treatment 2023. 62nd ed. McGraw Hill, 2023.

Professional Guide to Diseases. 11th ed. Wolters Kluwer, 2020

Terry, Peter B. Lung Disorders: Your Annual Guide to Prevention, Diagnosis, and Treatment. Remedy Health Media, 2013.