Lung Resection

ExitCare ImageA lung resection is surgery to remove a lung. When an entire lung is removed, the procedure is called a pneumonectomy. When only part of a lung is removed, the procedure is called a lobectomy. A lung resection is typically done to get rid of a tumor or cancer. This surgery can help relieve some or all of your symptoms. The surgery can also help keep the problem from getting worse. It may provide the best chance for curing your disease. However, surgery may not necessarily cure lung cancer, if that is the problem. Most people need to stay in the hospital for several days after this procedure.

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies to food or medicine.

  • Medicines taken, including vitamins, herbs, eyedrops, over-the-counter medicines, and creams.

  • Use of steroids (by mouth or creams).

  • Previous problems with anesthetics or numbing medicines.

  • History of bleeding problems or blood clots.

  • Previous surgery.

  • Other health problems, including diabetes and kidney problems.

  • Possibility of pregnancy, if this applies.

RISKS AND COMPLICATIONS

Lung resections have been done for many years with good results and few complications. However, all surgery is associated with possible risks. Some of these risks are:

  • Excessive bleeding.

  • Infection.

  • Inability to breath without a ventilator.

  • Persistent shortness of breath.

  • Heart problems, including abnormal rhythms and a risk of heart attack or heart failure.

  • Blood clots.

  • Injury to a blood vessel.

  • Injury to a nerve.

  • Failure to heal properly.

  • Stroke.

  • Bronchopleural fistula. This is a small hole between one of the main breathing tubes and the lining of the lungs.

BEFORE THE PROCEDURE

In order to prepare for surgery, your caregiver may ask for several tests to be done. These may include:

  • Blood tests.

  • Urine tests.

  • X-rays.

  • Imaging tests, such as CT scans, MRI scans, and PET scans. These tests are done to find the exact size and location of the tumor that will be removed.

  • Pulmonary function tests (PFTs). These are breathing tests to assess the function of your lungs before surgery and to decide how to best help your breathing after surgery.

  • Heart testing. This is done to make sure your heart is strong enough for the procedure.

  • Bronchoscopy. This is a technique that allows your caregiver to look at the inside of your airways. This is done using a soft, flexible tube (bronchoscope). Along with imaging tests, this can help your caregiver know the exact location and size of the area that will be removed during surgery.

  • Lymph node sampling. This may need to be done to see if the tumor has spread. It may be done as a separate surgery or right before your lung resection procedure.

PROCEDURE

  • An intravenous line (IV) will be placed in your arm. You will be given medicine that makes you sleep (general anesthetic).

  • Once you are asleep, a breathing tube is placed into your windpipe. You may also get pain medicine through a thin, flexible tube (catheter) in your back. The catheter is put through your skin and next to your spinal cord, where it releases anesthetic medicine.

  • Next, you will be turned onto your side. This makes it easier for your surgeon to reach the area of your ribcage where the surgical cut (incision) will be made. This area is washed with a disinfectant solution and might also be shaved. A catheter will be put into your bladder to collect urine. Another tube will be carefully passed through your throat and into your stomach.

  • The surgeon will make an incision on your side, which will start between two of your ribs and go around to your back. Your ribs will be spread and held open. Part of one rib may be removed to make it easier for the surgeon to reach your lung.

  • Your surgeon will carefully cut the veins, arteries, and bronchus leading to the lung. After being cut, each of these pieces will be sewn or stapled closed. Then, the lung or part of the lung will be removed.

  • Your surgeon will check inside your chest to make sure there is no bleeding in or around the lungs. Lymph nodes near the lung may also be removed for later tests. This is done to check if your problems have spread to the lymph nodes.

  • Depending on your situation, your surgeon may put tubes into your chest to drain extra fluid and air from the chest cavity after surgery. After the tubes are in, your ribcage will be closed with stitches. The stitches help your ribcage heal and keep it from moving. After this, the layers of tissue under the skin are closed with more stitches, which will dissolve inside your body over time. Finally, your skin is closed with stitches or staples and covered with a bandage.

AFTER THE PROCEDURE

  • After surgery, you will be taken to the recovery area where a nurse will monitor your progress. You may still have a breathing tube, spinal catheter, bladder catheter, stomach tube, and possibly chest tubes inside your body. These will be removed during your recovery. You may be put on a respirator following surgery if some assistance is needed to help your breathing. When you are awake, stable, and without complications, you will likely continue recovery in the intensive care unit (ICU).

  • As you wake up, you might feel some aches and pains in your chest and throat. Sometimes during recovery, patients may shiver or feel nauseous. Both of these symptoms are temporary and may be caused by the anesthesia. Your caregivers can give you medicine to help these problems go away.

  • The breathing tube will be taken out as soon as your caregivers feel you can breathe on your own. For most people, this happens on the same day as the surgery.

  • If your surgery and time in the ICU go well, most of the tubes and equipment will be taken out within the first 1 to 2 days after surgery. This is about how long most people stay in the ICU. You may need to stay longer, depending on how you are doing.

  • You should also start respiratory therapy in the ICU. This therapy uses breathing exercises to help your other lung stay healthy and get stronger.

  • As you improve, you will be moved to a regular hospital room for continued respiratory therapy, help with your bladder and bowels, and to continue medicines. Most people stay in the hospital for 5 to 7 days. However, your stay may be longer, depending on how your surgery went and how well you are doing.

  • After your lung or part of your lung is taken out, there will be a space inside your chest. This space will often fill up with fluid over time. The amount of time this takes is different for each person. Because your chest needs to fill with fluid, your surgeon may or may not put a drainage tube in your chest. If there is a chest tube, it will most likely be removed within 24 hours after the surgery.

  • You will receive care until you are doing well and your caregiver feels it is safe for you to go home or to transfer to an extended care facility.