Lung Resection (Lobectomy)

A lung resection (lobectomy) is a surgical procedure in which a surgeon removes one of the lobes (self-contained sections) of a lung to treat disease confined to that section.

Each lung is divided into lobes — the right lung has three and the left lung has two. When a disease such as cancer or a severe infection is limited to one lobe, removing that lobe can eliminate the problem while leaving the rest of the lung intact. The remaining lobes gradually expand to take over much of the breathing work, and most people adapt well over time.

Lobectomy is most often recommended when a disease is localised (contained) within a single lobe and the rest of the lung is healthy enough to compensate after surgery. The most common reason worldwide is lung cancer, but several other conditions can also require this operation.

• Non-small cell lung cancer (the most common type of lung cancer) that has not spread beyond the lobe
• Carcinoid tumours (slow-growing tumours that start in lung tissue)
• Severe bronchiectasis (permanent widening and scarring of the airways) limited to one lobe
• A lung abscess (a pocket of infection) that does not respond to antibiotics
• Tuberculosis (TB) complications, such as a destroyed lobe or a large cavity, that cannot be managed with medication alone
• Aspergilloma (a fungal ball that grows in a lung cavity) causing repeated bleeding
• Congenital (present from birth) lung abnormalities, such as congenital lobar emphysema (an over-inflated lobe that compresses surrounding tissue)

Lobectomy is generally not suitable for every patient. Your doctor will carefully assess overall health and lung function before recommending surgery. Situations where surgery is usually avoided include:

• Severely reduced lung function that would leave too little breathing capacity after removing a lobe
• Cancer that has already spread to multiple lobes or to other parts of the body
• Serious heart conditions or other major illnesses that make the risks of general anaesthesia (the deep sleep used during surgery) too high
• Very poor general health or very advanced age combined with significant other medical problems

Lobectomy is a major chest operation and carries real risks; your surgical team will discuss these with you in detail before you consent to proceed.

• Prolonged air leak — the most common complication, where air continues to escape from the cut lung tissue into the chest cavity for more than the usual few days
• Chest infection or pneumonia (lung infection) in the remaining lung tissue
• Atrial fibrillation (an irregular heartbeat) that often starts in the first few days after surgery and usually settles with treatment
• Bleeding inside the chest requiring a return to the operating theatre
• Deep vein thrombosis (a blood clot in a leg vein) or pulmonary embolism (a clot travelling to the lungs)
• Respiratory failure (the remaining lung struggling to provide enough oxygen), requiring temporary breathing support
• Wound infection at the incision site
• Bronchopleural fistula (an abnormal channel between the airway stump and the chest cavity) — uncommon but serious
• Damage to nearby structures, including nerves that control the voice box or the diaphragm (the main breathing muscle), causing a hoarse voice or breathing changes
• Risks of general anaesthesia, including reactions to the anaesthetic agent and, very rarely, serious cardiac events

Preparation for a lobectomy typically begins several weeks before the operation and involves both lifestyle steps and a series of tests to make sure the body can safely tolerate the procedure.

Lifestyle and medication adjustments your care team will usually advise include:

• Stopping smoking as early as possible before surgery — smoking increases the risk of chest infection and slows healing, and even a few weeks without smoking makes a meaningful difference
• Avoiding alcohol in the days leading up to surgery, as it can affect how the body responds to anaesthesia
• Pausing blood thinners (medicines that prevent clotting), anti-inflammatory medicines, and certain supplements such as fish oil, in the days before surgery — your doctor will give specific guidance based on your own medicines
• Fasting (eating and drinking nothing, including water) for the number of hours your anaesthesia team specifies — usually from midnight the night before, though your team will confirm the exact window

Before surgery is confirmed, you will usually undergo a set of tests to assess your lungs, heart, and general fitness. These commonly include:

• Pulmonary function tests (breathing tests that measure how much air the lungs can hold and move)
• CT scan of the chest to map the tumour or diseased area in detail
• PET scan (a scan that highlights areas of high cell activity) if cancer is suspected, to check for spread
• Bronchoscopy (a thin flexible camera passed into the airways) to inspect the airway and sometimes take a tissue sample
• Echocardiogram (an ultrasound of the heart) and EKG (a recording of the heart's electrical activity) to check heart function
• Blood tests, including full blood count and clotting tests
• A six-minute walk test or cardiopulmonary exercise test (CPET) to measure how well the heart and lungs work together under effort

On the day of surgery, the typical sequence of events is as follows, though the exact steps and their order can vary between hospitals and surgical approaches:

• 1. You arrive at the hospital and are admitted to a pre-operative (before surgery) preparation area.
• 2. A nurse checks your vital signs (blood pressure, heart rate, oxygen level) and confirms your identity, allergies, and fasting status.
• 3. An intravenous (IV) line is placed in a vein in your arm to deliver fluids and medicines during and after surgery.
• 4. The anaesthesiologist (specialist in anaesthesia and pain control) meets with you to review your medical history and explain the anaesthetic plan.
• 5. You are taken to the operating theatre and general anaesthesia is given, putting you into a deep, controlled sleep.
• 6. A double-lumen tube (a special breathing tube that allows each lung to be ventilated separately) is placed in your airway so the surgeon can work on one lung at a time.
• 7. The surgeon makes incisions (cuts) to access the chest. This is done either as open thoracotomy (a single large cut along the side of the chest) or as VATS — video-assisted thoracoscopic surgery (several small cuts through which a camera and instruments are passed). Your surgeon will have discussed which approach is planned for you.
• 8. The affected lobe is carefully separated from the rest of the lung, and the blood vessels and bronchus (the main airway branch) leading to it are sealed and divided.
• 9. The lobe is removed. The surgeon checks for air leaks and bleeding, and may send the tissue to a pathologist (a doctor who studies tissue under a microscope) immediately for examination.
• 10. One or two chest drains (thin tubes) are placed inside the chest cavity to allow air and fluid to escape while the remaining lung re-expands.
• 11. The incisions are closed and you are moved to the recovery area, where the anaesthesia is allowed to wear off under close monitoring.

Recovery from a lobectomy takes place in stages — first in the hospital, then at home over several weeks. Most patients spend time in a high-dependency or intensive care unit (ICU) immediately after surgery before moving to a general ward. The total hospital stay varies depending on which surgical approach was used, how quickly the air leak resolves, and each individual's overall health.

• Chest drains remain in place until air and fluid drainage has reduced to an acceptable level, typically for several days — nurses monitor the drainage output closely
• A physiotherapist (a specialist who helps restore physical function) will usually guide breathing exercises, called incentive spirometry (slow, deep breaths through a device), and gentle movement from the first day after surgery to help expand the remaining lung and prevent chest infection
• Pain is managed with a combination of methods, which may include an epidural (pain medicine delivered near the spine), nerve blocks, and oral pain medicines — good pain control allows deeper breathing and earlier movement
• Blood thinners are usually started soon after surgery to reduce the risk of blood clots, and compression stockings (tight socks that squeeze the leg veins) are worn during the hospital stay
• Diet is usually restarted gradually once the patient is alert and the bowel is moving normally
• The chest drain sites are checked regularly for signs of infection and are dressed as needed
• Lifting heavy objects and strenuous activity are restricted for several weeks — your surgical team will set a specific timeline for returning to each activity based on how you are healing
• Driving is usually not permitted until full shoulder and chest movement returns and pain medicines that cause drowsiness have been stopped
• A follow-up appointment is usually scheduled within a few weeks of discharge to check the wound, review any tissue biopsy (laboratory analysis of the removed lobe) results, and discuss whether further treatment such as chemotherapy or radiotherapy is needed
• For patients treated for cancer, longer-term follow-up with CT scans at regular intervals is usual to monitor for any return of disease
• Smoking cessation (quitting smoking permanently) is strongly encouraged, as continuing to smoke significantly increases the risk of complications and of the disease returning