Lobectomy for Lung Cancer

Primary lung cancer originates in the tissues of the lungs, windpipe (trachea) or main airway (bronchus). In many cases, the tumor begins in the cells that line the airways (bronchi) or small air sacs (alveoli). Secondary lung cancer occurs when cancerous cells break away from a tumor in another part of the body and spread to the lungs.

There are two main types of lung cancer: non-small cell lung cancer (NSCLC), which tends to grow slowly, and small cell lung cancer (SCLC), which is more aggressive. NSCLC is more common than SCLC, accounting for approximately 80% of lung cancer diagnoses.

Researchers have confirmed that smoking is the primary cause of lung cancer. Other risk factors include exposure to secondhand smoke, asbestos, radon gas and other environmental toxins. Symptoms can include persistent coughing, shortness of breath, chest pain and unexplained weight loss. An early diagnosis and treatment, which may involve surgery, radiation therapy and/or chemotherapy, can help ensure the best possible outcome and quality of life.

Why is lobectomy performed?

The lungs are divided into lobes and segments to help physicians identify and treat specific areas. The left lung has two lobes (upper and lower) and the right lung has three lobes (upper, middle and lower). Each lobe is further divided into segments. Lobectomy involves removing one lobe of a lung. This procedure may be considered to treat lung cancer or another lung condition that is localized to a single lobe. By removing the affected lobe, the surgeon can address the condition while preserving as much lung function as possible.

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Who is a good candidate for lobectomy?

Typically, a good candidate for lobectomy has early-stage NSCLC that is localized to a single lobe and has not metastasized to distant tissues or organs. The patient should also have good overall health and sufficient lung function to tolerate the surgery and recovery period. The procedure may also be suitable for a patient who has another lung condition, such as a benign tumor, localized infection or emphysema, that is significantly affecting a single lobe.

How to prepare for lobectomy

To prepare for lobectomy, the patient will undergo a comprehensive preoperative assessment, which will likely include blood work, a pulmonary function test and imaging scans, such as computed tomography (CT) or magnetic resonance imaging (MRI). Next, the patient will meet with the surgical team to discuss the procedure, anesthesia and postoperative care and ask any questions they may have.

The surgeon will provide specific instructions regarding any necessary adjustments to the patient’s medication use, such as temporarily stopping blood thinners before the procedure. If applicable, the patient should quit smoking as soon as possible to improve lung function and overall health. Additionally, consuming a healthy diet and engaging in light physical activity can be beneficial if advised by the surgical team. To prepare for anesthesia, the patient will be instructed to fast, typically beginning at midnight on the day before the procedure. Lastly, the patient should arrange for transportation home after surgery and assistance with daily activities during the initial days of their recovery.

What happens during lobectomy?

Depending on the location of the tumor, the patient’s general health and other factors, lobectomy may involve:

• Open surgery (thoracotomy) – To access the cancerous lobe, the surgeon will make a large incision in the chest wall. This approach typically requires a hospital stay of five to seven days.
• Robotic-assisted lobectomy – After making a few small incisions between the ribs, the surgeon will remove the cancerous lobe using advanced robotic technology, such as the da Vinci® Surgical System, for heightened visualization, flexibility, precision and control. Compared to open surgery, this minimally invasive approach typically results in a quicker recovery.
• Video-assisted thoracoscopic surgery (VATS) – After making several small incisions, the surgeon will insert a flexible tube with a miniature camera attached to the end (thoracoscope). Guided by detailed, real-time images of the surgical site, the surgeon will use special surgical tools to remove the cancerous lobe. Because VATS is a minimally invasive procedure that does not involve a large incision or spreading the ribs, it generally results in a quick recovery.

What are the risks and possible complications of lobectomy?

Lobectomy, while generally safe and effective, carries some risks and potential complications, such as:

• Infection at the surgical site
• Excessive bleeding
• Adverse reaction to anesthesia
• Pneumonia
• Collapsed lung (pneumothorax)

While recovering from lobectomy, the patient may have pain at the incision site, reduced lung function and difficulty breathing, and possibly numbness or weakness in the chest or shoulder due to nerve irritation. Attentive postoperative care can minimize these risks and help ensure a successful recovery.

What to expect during recovery from lobectomy

After lobectomy, the patient can expect an initial hospital stay of approximately four to seven days. Discomfort at the incision site is common and can usually be managed with pain medications. The patient will be encouraged to perform breathing exercises and use an incentive spirometer to help expand the lungs and prevent complications, such as pneumonia. Beginning with gentle movements and short walks, physical activity will be gradually increased to promote blood circulation and improve lung function. The patient may have a chest tube in place for a few days to drain excess fluid or air from the chest cavity.

Regular follow-up appointments will be scheduled to monitor the patient’s healing and lung function. Full recovery can take several weeks to months, during which the patient should avoid strenuous activities and closely follow their surgeon’s postoperative guidelines.

How effective is lobectomy?

Lobectomy can be effective for treating early-stage NSCLC and other localized lung conditions. Overall, the procedure is considered a standard, safe and effective treatment, offering a better quality of life and a potential cure for certain patients.

Benefit from world-class care at Moffitt Cancer Center

Moffitt is a high-volume cancer center, and our board-certified, fellowship-trained thoracic surgeons have acquired highly focused experience in performing lung cancer surgery using the latest techniques and technologies, including robotic-assisted surgery and sleeve lobectomy. Additionally, through our robust portfolio of clinical trials, our patients have unique opportunities to benefit from promising new surgical approaches that are not yet widely performed.

If you would like to learn more about lobectomy, you can request an appointment with a specialist in Moffitt’s Thoracic Oncology Program by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.