Definition & Overview
Pulmonary wedge resection is a surgical procedure that removes a small, wedge-shaped section of the lung tissue from one lobe of the lungs. It is commonly performed to remove a portion of the lung that contains cancerous cells, along with surrounding nearby healthy tissue.
The lungs are the main organs through which we breathe. They are responsible for transporting much-needed oxygen into the blood, and removing waste carbon dioxide from the bloodstream. They are located on both sides of the heart and are protected by the chest cavity. The left lung has two lobes, while the right lung has three. Lung disease, such as cancer or tumour growth, can undermine the important function of the lungs. When the entire lobe of either lung has to be removed along with these abnormal structures (through lobectomy), a significant reduction in lung function occurs and breathing may be compromised.
Wedge resection of the lung is an alternative to lobectomy (complete removal of a lung lobe) and aims to conserve part of the affected lobe.
Who Should Undergo and Expected Results
Lung resection is performed in patients with lung cancer or lung disease. In many cases, especially when the disease or tumour is discovered early, wedge resection can provide a complete cure for the condition. It is most effective when performed in early stage lung cancer, and is also a routine procedure to remove a section of the lung if cancer is suspected (but yet to be confirmed).
In particular, pulmonary wedge resection is indicated for the following conditions:
- Early stage lung cancer that is confined locally to the tissue lining the airways (and have yet to involve nearby lung tissue)
- Tumour localised at the sides of the lungs
- Lung nodules and lesions present in localised area of the lung
- Tuberculosis (lung infection) that is untreatable with medication and other interventions
How is the Procedure Performed?
Pulmonary wedge resection is performed under general anaesthesia. Before the procedure, patients are instructed to avoid eating or drinking the night before, and to stop smoking at least two to three weeks prior to surgery.
The procedure can be performed in two ways: through traditional open surgery or a more advanced minimally invasive surgical technique.
Open surgery: In this procedure, the surgeon creates a long incision in between the ribs, as well as incisions under the armpit and on the side of the affected lung.
Minimally invasive video-assisted thoracoscopic surgery (VATS): With VATS, the surgeon makes 2-3 small incisions in the chest region through which the chest cavity is viewed and accessed. Special surgical instruments are inserted through these incisions as wedge resection is performed. Minimally invasive VATS can reduce the duration of hospital stay, as well as lessen post-operative pain, recovery time, the risk of nerve damage, and infection risk.
In both cases, the lungs have to be temporarily collapsed while a certain portion of the organ is removed. After resection is completed, the incisions are stitched or sutured. A tube is also inserted into the chest cavity to drain fluids. The chest tube is usually maintained for several days until the incisions are healed.
After the procedure, patients are closely monitored for a few days (2-3 days for VATS and 5-7 days for open surgery). Pain medicines are usually administered, and a ventilator is used to help patients breathe. When the ventilator is no longer necessary, patients are guided in restoring normal lung function (i.e. proper breathing, coughing, and breathing exercises).
When used as treatment for lung cancer, wedge resection is often performed in conjunction with other cancer treatment including chemotherapy and/or radiation therapy.
Possible Risks and Complications
Risks and complications of pulmonary wedge resection can be reduced with technologically advanced video-assisted thoracoscopic surgery. However, although reduced, complications may still occur, as such is the case in just about any surgical procedure. Among rare complications that can occur are:
- Excessive bleeding
- Unwanted reaction to anaesthesia applied
- Air leakage due to injury incurred in the pleura (in between the lungs and chest cavity)
- Intercostal nerve damage
- Infection in the pleura, or in between lung linings
- Infection in the incisions made
- Residual air space, which occurs when a big portion of the lung is removed
- Respiratory failure in those with compromised lung function
- Abnormal heart rhythms, or heart attack
Patients must call the attention of the doctor should the following symptoms develop:
- Increased pain, redness or swelling at the incision site
- Chest pain
- Fever and chills
- Shortness of breath or breathing difficulties
- Pain in the calves (may be linked to abnormal blood clotting)
- Throwing out of green- or yellow-coloured or blood-tinged sputum
Overall, however, pulmonary wedge resection is a safe, effective, and reliable procedure for removal of lesions and cancerous tumours in localised areas of the lung. It is highly effective in treating early stages of lung cancer and lung disease with good prognosis.
Shennib HA, Landreneau R, Mulder DS, Mack M. Video-assisted thoracoscopic wedge resection of T1 lung cancer in high-risk patients. Ann Surg. 1993 Oct. 218(4):555-8; discussion 558-60.
Sakuma T, Sugita M, Sagawa M, Ishigaki M, Toga H. Video-assisted thoracoscopic wedge resection for pulmonary sequestration. Ann Thorac Surg. 2004 Nov. 78(5):1844-5.