What is lung resection?

In medical terms, ‘resection’ means to remove part or all of an organ or tissue. So, a lung resection is surgery to remove part or all of a lung. Doctors use this surgery to treat severe lung diseases, including lung cancer.

Each of your lungs connect to your windpipe, or trachea, via a main airway, or bronchus. The two lungs differ somewhat in size. Your right lung is the larger of the two. It consists of three lobes—an upper (superior) lobe, middle lobe, and lower (inferior) lobe. Your left lung is smaller to make room in your chest for your heart. It only has an upper lobe and a lower lobe. The extent of lung resection surgery will depend on how much of these tissues the disease affects. It also depends on the strength of your remaining lung function.

There are four main types of lung resection surgery:

• Wedge resection removes only part of a lobe. For lung cancer, doctors may recommend this surgery if you do not have enough lung function to tolerate removal of the whole lobe. Other names for this procedure include segmentectomy and thoracic wedge.

• Lobectomy removes an entire lobe. If lung cancer remains contained in one lobe, this is the procedure doctors often prefer to use.

• Sleeve resection removes a tumor in one of the large or main airways. It involves cutting out a section of the airway and joining the two ends. The term “sleeve” comes from the idea of the airway being like a shirtsleeve. You can remove a section of the sleeve and sew it back together.

• Pneumonectomy removes an entire lung. This surgery may be necessary if the tumor is near the center of the chest or if there are tumors in more than one lobe.

 

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Why is lung resection performed?

Lung cancer is the most common reason to need a lung resection. Because lung cancer is very hard to treat, doctors often opt for the most extensive surgery you can tolerate. This offers the best chance of removing all the cancer. Sometimes, they can accomplish this with a wedge resection of the lung. However, when removing a smaller portion of the lung won’t treat the cancer, a lobectomy or pneumonectomy may be necessary.

Doctors may recommend a lung resection to treat other conditions when there are no other treatment options. This includes:

• Extreme trauma to the lung

• Severe, chronic lung infection, such as fungal infections, multiple lung abscesses, or tuberculosis

• Severe, congenital lung disease, which is a birth defect

Lung resection is major surgery. Talk with your doctor about all risks and benefits of the procedure beforehand. Consider getting a second opinion about your treatment options before deciding on surgery.

 

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Who performs lung resection?

A thoracic surgeon performs lung resection. This doctor specializes in surgery of the chest, including the lungs, esophagus, heart, and major blood vessels. Cardiothoracic surgeon is another name for this type of surgeon. A surgical oncologist may also perform lung resection in some cases.

 

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How is lung resection performed?

Lung resection is major surgery that takes place in a hospital. It requires general anesthesia to put you in a deep sleep during the surgery. You will not be awake or feel any pain. There are two basic approaches to lung resection:

• Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgery. It involves inserting special instruments and a thoracoscope through small incisions in your chest. A thoracoscope is a thin, lighted instrument with a small camera. It transmits pictures of the inside of your chest to a video screen. Your surgeon views the video screen while performing surgery. Specially trained surgeons perform this type of lung surgery.

• VATS generally involves a faster recovery and less pain than open surgery. However, this procedure may not be available at all surgical centers. High-volume centers are more likely to offer this option.

• Thoracotomy is traditional open surgery. It involves making a large incision in the chest between the ribs. Open surgery allows your surgeon to directly view and access the surgical area.

Open surgery usually involves a longer recovery and more pain than minimally invasive surgery. It also requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective choice for some people.

What to expect the day of your lung resection

In general, this is what happens the day of your surgery: 

• You will talk with a preoperative nurse who may perform an exam. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

• You will change into a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. You will have blankets for modesty and warmth.

• You will talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.

• You will get an intravenous (IV) line and a sedative to help you relax before the team takes you to the OR (operating room).

• Your team will start general anesthesia in the OR. You won’t remember anything else until you wake up in the recovery room.

Your team will monitor your vital signs during surgery. This will continue throughout your recovery until you are breathing effectively and your vital signs are stable.

 

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What are the risks and potential complications of lung resection?

All surgeries involve risks and possible complications. Some of these can be serious and may develop during surgery or while you are recovering.

General risks of surgery

The general risks of surgery include:

• Anesthesia reaction, such as an allergic reaction and problems with breathing

• Bleeding, which can lead to shock

• Blood clot, in particular a deep vein thrombosis (DVT) that develops in the leg or pelvis. A DVT can travel to your lungs and cause a pulmonary embolism.

• Infection

Potential complications of lung resection

Most lung resection surgeries are successful, but potential complications include:  

• Abnormal heart rhythm (arrhythmia)

• Buildup of fluid in the space left by the lung

• Collapsed lung

• Leakage of air into the chest between the lung and the chest wall

• Movement of organs and tissue into the space left by the lung

Chest and lung surgery also carries a risk of respiratory failure and death.

Reducing your risk of complications

You can reduce your risk of certain complications by:

• Following your doctor’s instructions for activity and dietary restrictions and recommendations

• Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

• Taking your medications exactly as directed

• Telling all members of your care team if you have allergies

 

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How do I prepare for lung resection?

There are steps you can take before surgery that can improve comfort and outcome. You can prepare for lung resection by:

• Getting preoperative testing if your doctor orders it

• Losing excess weight before surgery

• Making sure all your healthcare providers have your complete medical history. This includes chronic conditions, allergies and medications. When listing medications, include prescriptions, over-the-counter drugs, herbal treatments, and vitamin supplements.

• Not eating or drinking before surgery as directed

• Stopping smoking as soon as possible to help the healing process

• Taking or stopping medications as directed

Questions to ask your doctor

Making a list of questions can help you remember everything you want to ask your doctor. Your questions may include:

• Why do I need lung resection? Are there any other options for treating my condition?

• What type of lung resection procedure will I need?

• How long will the surgery take? When can I go home?

• What restrictions will I have after the surgery?

• What kind of assistance will I need at home?

• When can I return to work and other activities?

• What medications will I need before and after the surgery? How should I take my usual medications?

• How will you treat my pain?

• What type of rehabilitation and physical therapy will I need?

• When should I follow up with you?

• How should I contact you? Ask for numbers to call during and after regular hours.

 

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What can I expect after lung resection?

Knowing what to expect makes it easier to plan and prepare for a successful recovery.

How long will it take to recover?

After lung resection, you will spend time in the ICU (intensive care unit). You need the 24-hour intensive monitoring these units provide. It’s common to stay in the hospital for about a week after lung resection. The length of your stay may vary depending on your age and overall health.

Rehabilitation—or rehab—will help you recover and learn how to compensate for the loss of lung tissue. Physical therapy, respiratory therapy, and other therapies will be part of your rehab. They aim to improve your circulation, endurance, strength, and lung capacity. Your therapists will tell you when you can return to normal activities. Full recovery from lung resection can take up to two months, but everyone is different. Your age and overall health before surgery can influence your recovery time.

Will I feel pain?

You will have pain and soreness after lung resection. Controlling pain is important for healing and a smooth recovery. It lets you complete the rehab activities, including deep breathing exercises that are necessary for your recovery. Tell your doctor if your pain changes in any way. It could be a sign of a complication.>

When should I call my doctor?

Contact your doctor’s office if you have questions between follow-up appointments. However, call your doctor right away or seek immediate medical care if have:

• Breathing problems or shortness of breath

• Confusion or changes in level of alertness

• Chest pain, pressure or tightness

• Drainage of pus, redness or swelling around your incision

• Fever. It’s common to have a fever right after surgery. Your doctor will give you instructions about when to call for a fever.

• Inability to urinate or move your bowels

• Leg pain, redness or swelling, which could mean you have a blood clot

• Severe nausea and vomiting

• Unexpected bleeding

How might lung resection affect my everyday life?

The goal of lung resection is to treat severe lung disease. However, the surgery can leave you with ongoing shortness of breath. It’s common to experience this even at rest, without exerting yourself at all. You may need to wear oxygen to manage this. Your doctor may also restrict the kinds of work and activities you can do. Your doctor is the best resource for information about your prognosis and long-term outlook. Ask your doctor what you can expect based on your circumstances.