Lung Lobectomy: An Overview

Introduction:

Lung lobectomy refers to the surgical removal of the lobe of the lungs. It is a procedure performed to treat benign and malignant lung diseases. It involves the removal of a diseased portion of the lung. After the removal, the remaining healthy tissues function normally. It is a minimally invasive procedure that conserves lung function.

What Is Lung Lobectomy?

Lung lobectomy is performed if lung cancer affects one of the lobes of the lungs. The affected or the diseased lobe is surgically removed. This procedure cannot be performed if cancer involves the entire lungs. It is usually performed for non-small cell lung cancers because it is confined to a single lobe. Sleeve lobectomy is a different procedure involving removing a lobe and a portion of the airway.

What Are Lung Lobes?

The right and the left lungs are asymmetrical and consist of lobes. The right lung comprises three lobes: the right upper lobe, the middle lobe, and the right lower lobe. The left consists of two lobes: the left upper lobe and the left lower lobe. The right lobes are divided by an oblique fissure and a horizontal fissure. The left lobes are divided by an oblique fissure. The lobes divide into segments that are associated with bronchi. In some conditions, accessory lobes may be present.

What Are the Types of Lung Lobectomy?

Lung lobectomy is performed by conventional technique, video-assisted thoracoscopic surgery (VATS), or robotics.

• Conventional Open Lobectomy - It is an open surgical technique done through posterolateral thoracotomy. It is done for lung cancer and other complex benign conditions. It is usually performed for conditions like centrally located tumors, tumors greater than 2.36 inches, endobronchial tumors, congenital lung malformations, and thick adhesions in inflammatory processes.

• VATS Surgery - It is a minimally invasive surgical technique. It is performed through an anterior utility port incision, anterior surgeon's position, anterior hilum approach, or anterior-to-posterior hilum dissection sequence techniques. This technique offers fast recovery with limited postoperative complications. The severity of pain and blood loss is less during this surgery. However, this technique cannot be performed for larger tumors, and sometimes, a few cancer cells may be missed during removal. Therefore, the open technique is more convenient in the majority of cases.

• Robot-Assisted Thoracoscopic Surgery (RATS) - This procedure is similar to VATS but performed with robots. It causes fewer complications. It is used in stage three non-small cell lung cancers.

The surgical technique is decided based on the characteristics of the cancer, the tumor's location, size, the extent of the spread, pain, lung function, and general health.

What Are the Other Types of Lung Surgeries?

Various lung surgeries are performed to treat lung cancers depending on the type of cancer and its extent.

The following are the other techniques:

• Pneumonectomy - This procedure involves the removal of the entire lungs.

• Segmentectomy or Wedge Resection - A portion of the lobe is removed, unlike lobectomy, which involves the removal of the entire lobe.

• Sleeve Resection - The affected portion of the airway and the tumor is removed, and the remaining portion is joined to form a short sleeve.

What Are the Indications for Lung Lobectomy?

Lung lobectomy is indicated in the following conditions:

Benign conditions like infections, developmental anomalies, and bleeding.

• Infections - Chronic infections that antibiotics cannot control, require lobectomy. It is commonly performed in tuberculosis (bacterial infection). Also, it is done for tuberculous patients with complications like a large cavity or localized bronchiectasis.

• Developmental Anomaly - Lung lobectomy is performed in conditions like pulmonary sequestration (the situation in which the lung tissue receives blood supply from an anonymous artery), bronchogenic cysts (abnormal tissue growth that separates the lungs), congenital cystic adenomatoid malformation (non-cancerous abnormal lung tissue), and congenital bronchial atresia (interrupted bronchus).

• Bleeding - Bleeding due to aspergilloma (fungus balls), cavity, arteriovenous malformation, and bronchiectasis (chronic lung disease) can be treated with lobectomy. It is indicated in trauma to hilar vessels or bronchi hilar injuries.

• Malignant Conditions - The procedure is commonly performed in stage I and II non-small cell lung cancer. Lung cancer usually affects the right upper lobe. The right upper lobectomy is the most common procedure for treating lung cancer. It is performed for malignant conditions like mucoepidermoid tumors (salivary gland tumors), adenoid cystic tumors (salivary gland tumors), and sarcomas (cancer affecting bone and soft tissue). It can also be performed in patients with localized pulmonary metastasis.

What Are the Contraindications for Lung Lobectomy?

It is contraindicated for individuals with forced expiratory volume in one second less than 800cc or diffusion capacity of carbon monoxide less than forty percent. It is not indicated for patients with recent myocardial infarction and severe cardiovascular diseases. Video-assisted thoracoscopic surgery (VATS) is contraindicated for patients with tumors larger than 2.36 inches.

Why Is Lobectomy Performed?

Lung lobectomy is the most common treatment procedure to treat lung cancer. It is done to remove the lung's cancerous portion and prevent cancer spread. The affected portion is removed to allow normal functioning of the remaining healthy lung tissues. It is a conservative procedure compared to pneumonectomy, which involves the removal of entire lungs. Lobectomy is performed in benign tumors of the lungs. A benign tumor does not spread but presses against the blood vessels and prevents blood flow. Lobectomy with the tumor enhances the blood flow.

What Is the Procedure of Lobectomy?

• Patient Preparation:The healthcare provider may ask the patient to sign the consent and the patient should inform the healthcare provider if they are pregnant, allergic to dye, allergic to medicines, or bleeding disorder. Patients should stop smoking before the procedure.

• Procedure: An intravenous line is put into the arm. After giving anesthesia, the healthcare provider will cut over the chest. The special tool is used to take apart the ribs and remove the affected lobe of the lung. The cut is closed with the stitches.

What to Expect After Lung Lobectomy?

Breathing techniques and coughing exercises improve breathing and prevent infections. It also helps to expand and contract the lungs.

The following should be avoided during the healing processes:

• Smoking.

• Exposure to chemical fumes and harmful vapors.

• Environmental pollution.

• Contact with people with infections like cold and flu.

It is important to consult the doctor on experiencing the following symptoms after surgery:

• Shortness of breath.

• Difficulty breathing.

• Pain.

• Cough, cough with yellow, green, or bloody sputum.

• Redness, swelling, or pain around the incision.

• Fever.

• Changes in the mental state.

What Are the Complications of Lung Lobectomy?

The postoperative complications of lobectomy include:

• Prolonged air leak.

• Subcutaneous emphysema (lung disease).

• Pneumonia.

• Mucus plugs.

• Lung collapse.

• Pleural empyema (pus collection in the pleural cavity).

• Persistent space.

• Atrial fibrillation (irregular heart rhythm).

• Right middle lobe torsion.

• Bleeding.

• Chylothorax (leakage of fluid from the lymphatic system to space around the lungs).

• Phrenic nerve injury (diaphragm weakness).

• Recurrent laryngeal nerve injury.

• Infection.

• Tumor embolization (cut off supply to the tumor).

• Bronchopleural fistula (connection between the bronchus and pleural space).

Conclusion:

Lung lobectomy is a minimally invasive surgery to treat lung cancer and other lung conditions. It is a conservative procedure that preserves lung function. It prevents and slows the spread of cancer, infections, and diseases. Advancements in lung surgery techniques have been useful in preserving lung function. The patient should know the risks and benefits of the procedure before undergoing lung lobectomy.