Lung Resection

Alternate Names
lobectomy
pneumonectomy
wedge resection
removal of lung tissue

Definition of Lung Resection

A lung resection is a surgical procedure to remove a portion of the lung or the whole lung.

Who is a candidate for the procedure?

A lung resection is usually performed on a person with a diseased or damaged lung. Reasons for lung resection include:

• cancer or other tumors of the lung
• lung conditions that cause secondary disease, such as dilated bronchi, or tubes leading to the lungs, known as bronchiectasis
• lung disease, such as emphysema
• lung infection, such as tuberculosis
• lung abscess, or pus pocket
• atelectasis, or a collapsed lung

Pulmonary function tests are performed before the procedure to assure as well as possible, that the person will have enough lung function remaining to survive after the diseased lung or section of lung is removed.

How is the procedure performed?

Lung resection is performed under general anesthesia, meaning the person is put to sleep with medication. To perform a lung resection, the surgeon makes an incision in the chest. If necessary, a rib is removed from the chest to gain better access to the diseased part of the lung. The lung is examined and the area of concern, such as a tumor, is identified.

The blood vessels that supply the area to be removed are sutured (tied off), and cut. The tumor or diseased area is then removed. If malignant tumors are removed, the lymph nodes near the lung and draining the lung are also removed. After removal of the diseased area, the muscles are sutured and reconstructed where necessary. A chest tube is left in place to remove fluid, blood, and air from the lung and chest wall. The incision is closed with sutures, clips, or staples.

What happens right after the procedure?

Usually the person spends a few hours in the surgery recovery room to monitor blood pressure, heart rate, and breathing. The person is also watched for any problems with bleeding or reaction to the anesthesia. For at least 4 to 5 hours, the person will not be able to drink anything. Then small sips of clear fluids can be taken as tolerated.

An intravenous line (IV) is usually left in a vein in the arm so fluids can be given. This ensures that the person does not get dehydrated. The IV is usually left in place for about 24 hours, or until the person is able to take fluids and the pain is under control. Pain medication can be given in the IV line or injected into the muscle. As soon as the pain decreases and the person is tolerating fluids, pain medication may be given orally.

Antibiotics may also be given to decrease the risk of infection. Usually a few drainage tubes are left near the incision to allow air, fluids, and blood to drain. These drainage tubes are also used to decrease the risk of atelectasis, which is a collapsed lung. The tubes can be removed once the draining subsides and the lung is fully re-expanded.

A nasogastric tube (NG) may also be placed to allow drainage from the stomach. Often oxygen is given through a facemask or a nasal cannula, a tube that goes a little way inside the nose. Some people may need to be on a ventilator, or artificial breathing machine, for a few hours or days after surgery.

Deep breathing is encouraged for the first few days after surgery to help prevent pneumonia. The day after surgery, the person is encouraged to get up and move around. This helps to decrease the risk of blood clots in the pelvis and legs, known as deep venous thrombosis. The hospital stay is usually 6 to 10 days.

What happens later at home?

After a lung resection, the person is taught how to care for the incision. Activity at home is based on how the person is feeling. Activity is advanced slowly as the person regains his or her strength. It may be a few weeks before driving, returning to work, or strenuous activity is advised. If the surgery was done to remove a tumor, radiation therapy, or chemotherapy may be needed.

What are the potential complications after the procedure?

Like any surgery, lung removal can be complicated by bleeding, infection, or an allergic reaction to the anesthetic. Any small air hole left after surgery may allow air to leak from the lung into the chest, causing atelectasis. This surgery may also place a person at risk for pneumonia. In addition, sometimes a person has a hard time coming off ventilatory support, especially if the capacity of the remaining lung is marginal.

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