Definition and Overview
The partial removal of the lung is a surgical procedure performed for the treatment of lung conditions including lung cancer.
There are many different types of partial lung removal surgery depending on which part of the lung is removed. These include:
Lobectomy - Removes an entire lobe that contains a malignant tumour as part of cancer treatment. The lungs have a total of five lobes, 3 of which make up the right lung and two the left lung. Of all the different types of lung removal surgery, this is the most preferred.
Pneumonectomy - Removes an entire lung if there is a malignant tumour or lesion near the centre of the chest.
Segmentectomy - Also known as a wedge resection, this procedure removes only a portion of a lobe. It is an alternative option if a lobectomy cannot be performed due to the patient's overall health condition.
Surgeons decide on the most appropriate procedure depending on the size and location of the diseased part of the lung and how well the lungs are functioning. If a person’s lungs are in relatively good health, doctors often recommend a more aggressive procedure.
Who Should Undergo and Expected Results
Partial lung removal surgery is beneficial for patients who suffer from:
Benign tumours/lesions in the lung
Haemothorax (blood clots in the lungs)
Solitary pulmonary nodules
Empyema (infection in the chest cavity)
Of all these diseases, lung cancer is the most common reason why lung removal procedures are performed. Lung cancer surgery is, in fact, the primary treatment for early stage non-small cell lung cancer (NSCLC). The procedure is known to provide patients with the best chance of cure for their condition.
Prior to the procedure, patients undergo several pulmonary function tests to determine how much healthy lung tissue will remain after surgery and if this is sufficient to retain normal lung function for the patient. The doctor may also perform a lung biopsy, in which a small sample of the lung tumour and parts of lymph nodes near the lungs are taken to check for malignant cells and possible cancer spread.
Despite its important role in the treatment of early stage lung cancers, the procedure is not particularly effective for advanced stage lung cancers, especially if tumours have already spread to the lymph nodes between the lungs.
How is the Procedure Performed?
There are two ways through which partial removal of lung can be performed. The first is the more traditional method called thoracotomy, which involves making a large chest incision and spreading out the ribs to gain access to the lungs. In some cases, surgeons may also need to remove a rib. Open lung surgery usually takes between two and six hours.
The other method is called minimally invasive video-assisted thoracic surgery (VATS), which is the preferred procedure for early stage lung cancers. Instead of making a large chest incision, the surgeon makes several tiny cuts in the side of the chest where a thin tube with a video camera attached to its end and other specialised surgical instruments are inserted. The video camera sends live images of the inside of the chest cavity to a computer monitor, providing the surgeon with visual guidance. One of the cuts is then enlarged in order to take out the removed portion of the lung. After surgery, a tube is attached to the chest to drain excess fluid and air from the surgical site. Patients who undergo this procedure have to stay in the hospital for four to five days.
Recovery from a partial removal of lung may take several weeks to a few months, especially if surgery involved a large chest incision. Patients who undergo VATS as well as those whose lungs are in good condition recover faster.
Possible Risks and Complications
Patients may experience some side effects following a partial lung removal, such as shortness of breath after certain levels of activity. These side effects are usually more bothersome for patients who have another lung disease or are long-time smokers.
Lung cancer surgery patients also face some potential complications, such as:
Failure of the lung to expand
Injury to nearby organs and blood vessels including the diaphragm, trachea, and oesophagus
Prolonged air leakage
Fluid buildup in the chest cavity
Disturbances in heart rhythm
They are also at risk of complications commonly associated with any type of surgery, including:
Blood clots in the legs or lungs
Adverse reactions to anaesthesia
To minimise the above risks, patients must follow their doctor’s instructions before the procedure. They should avoid taking drugs that make it hard for blood to clot and stop smoking several weeks before the procedure.
There are also some precautions that should be taken after surgery. Patients are given medications and compression stockings to prevent blood clots and are advised to do deep breathing exercises to prevent lung infection and pneumonia.
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Sheikh SI, McCoy K, Ryan-Wenger NA, Patel A, Kirkby S. “Lobectomy in patients with cystic fibrosis.” Can Respir J. 2014 Jul-Aug; 21(4): e63-e66. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173894/
Jie Xiang, Su Yang, Wei Guo, Runsen Jin, Yajie Zhang, Xingshi Chen, Han Wu, Hailei Du, Dingpei Han, Kai Chen, Hecheng Li. “Robotic-assisted thoracoscopic surgery: left upper lobectomy.” AME Medical Journal. http://amj.amegroups.com/article/view/3675/4409