Lobectomy
Lobectomy, also known as pulmonary lobectomy, is a surgical procedure that involves the removal of a lobe of the lung. It is primarily performed to treat lung cancer, particularly non-small cell lung cancers (NSCLC), as well as conditions such as bronchiectasis, tuberculosis, lung abscesses, localized fungal infections, chronic obstructive pulmonary disease, and emphysema-related blebs. This procedure is less invasive than pneumonectomy, which entails the removal of an entire lung, but more invasive than a wedge resection, which removes only a small part of the lung.
Advancements in surgical techniques have led to the development of video-assisted thoracic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS), both of which offer minimally invasive options with potentially fewer complications compared to traditional open lobectomy. Patient preparation for lobectomy includes various diagnostic studies to evaluate lung function and overall health, followed by careful monitoring during and after the surgery.
After the procedure, patients are usually transferred to the intensive care unit for close observation. While lobectomy can have risks, such as prolonged air leaks and infections, it is associated with favorable outcomes for early-stage lung cancer, boasting a five-year survival rate of approximately 70%.
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Lobectomy
ALSO KNOWN AS: Pulmonary lobectomy, lung lobe removal
DEFINITION: Lobectomy is the surgical removal of a lobe of a lung.
Cancers treated:Lung cancer, most commonly non-small cell lung cancers (NSCLC)
Why performed: Lobectomy is a surgical procedure used to treat lung cancer when the tumor is limited to one area of the lung. It may also be used to treat bronchiectasis, tuberculosis, lung abscess, localized fungal infections, chronic obstructive pulmonary disease, or blebs associated with emphysema. It is less invasive than a pneumonectomy, which removes the entire lung, but more invasive than a tumor removal using a wedge resection. In the early 2010s, some medical facilities began offering video-assisted thoracic surgery (VATS) as a form of less-invasive lobectomy when the cancer is in its early stages. This was soon followed by robot-assisted thoracoscopic surgery (RATS). VATS and RATS procedures result in fewer post-operative complications than open lobectomy procedures. The choice of procedure type depends on the cancer type, location, size, and whether it has spread.
Patient preparation: Before surgery, studies are performed to check for abnormalities and establish a baseline for postoperative comparison. These studies include a chest X-ray, electrocardiogram (ECG), bleeding time, and blood tests to check kidney function, electrolytes, hemoglobin, oxygen levels, and white blood cell count. Pulmonary function tests are performed to evaluate lung function. A blood sample is also drawn to check the patient’s blood type in case a transfusion is needed during surgery. The patient must not eat or drink for at least eight hours before surgery, and an intravenous (IV) is inserted for fluids and medications. An indwelling urinary catheter may also be inserted so that urine output can be monitored closely during and after the procedure.
Steps of the procedure: When the patient arrives in the operating suite, an arterial catheter may be inserted to monitor the patient’s blood pressure and oxygenation. After the patient is anesthetized, the surgeon makes an into the chest cavity. When the chest cavity is entered, the lung collapses. The surgeon locates and ties off sources of bleeding, spreads the ribs, and exposes the area of the lung for removal. The surgeon removes the affected lung lobe and repairs the vessels and lung passages from where it was removed. The surgeon inserts one or two chest tubes to drain fluid and reexpand the lung. Then, the surgeon closes the chest cavity and applies a sterile dressing.
After the procedure: The patient is typically transferred to the intensive care unit (ICU) and attached to a monitor that displays heart rhythm, blood pressure, and oxygen saturation. These devices help the ICU nurses closely monitor the patient’s condition. The patient receives supplemental oxygen and IV fluids. The nurses check the chest tube drainage frequently to monitor for excess bleeding. The patient is encouraged to turn, cough, breathe deeply, and use an incentive spirometer to prevent pneumonia. Sequential compression devices are attached to the patient’s legs to help prevent blood clots. Most patients who undergo VATS or RATS procedures have shorter recovery periods than those who undergo open lobectomy.
Risks: The most common complication associated with a lobectomy is a prolonged air leak, which requires a chest tube to be placed for several days. Other risks include surgical site infection, bleeding, pneumonia, hemorrhage, heart problems, blood clots, and respiratory failure. Some research suggests open lobectomy procedures result in an increased risk of complications.
Results: Pathologic examination of the lung specimen reveals the type of cancer. When a lobectomy is performed on early-stage lung cancer, long-term survival is likely. The five-year survival rate is around 70 percent.
Bibliography
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