Pulmonary Resection

Pulmonary resection is a major surgical procedure to remove part or all of a damaged or diseased lung. While it represents a serious operation, people can live with only one lung or with part of a lung removed, making this an important treatment option for various lung conditions.

Table of contents

• What is Pulmonary Resection?
• Conditions Treated with Pulmonary Resection
• Types of Pulmonary Resection
• Surgical Approaches
• Preparing for Surgery
• What to Expect During the Procedure
• Recovery and Post-Operative Care
• Risks and Complications

What is Pulmonary Resection?

A pulmonary resection, also called a lung resection, is surgery to remove part or all of your lung^[1]. Surgeons remove the portion of your lung that is damaged or diseased from cancer, infections, or inflammation^[1]. Healthcare providers can also use this procedure to obtain tissue samples to help diagnose lung conditions through a biopsy (a medical test where a small sample of tissue is removed for examination)^[1].

Each lung is divided into sections called lobes (separate divisions within the lung). You have two lobes in your left lung and three in your right^[1]. A lung resection can remove an entire lobe, parts of a lobe, or the entire lung. Lung resection is a major surgery, but you can live with only one lung or with part of a lung removed^[1].

• Lungs
• Bronchus (airway)
• Pulmonary vessels
• Lymph nodes

Conditions Treated with Pulmonary Resection

Healthcare providers perform a lung resection to treat several different conditions affecting the lungs. The procedure is most commonly used for lung cancer, but it can address various other lung diseases and injuries^[1].

For treatment purposes, pulmonary resection is used for lung cancer in stages I, II, and sometimes III^[1]. It can also treat cancer that has spread to your lungs from other organs, known as metastatic cancer (cancer that has moved from where it started to another part of the body)^[1]. Other conditions include benign lung tumors or lung nodules, bronchiectasis (a condition where the airways become damaged and widened), emphysema (a lung condition causing shortness of breath), abscesses (collections of pus in the lung), and lung injuries from blunt force or penetrating trauma^[1].

For diagnostic purposes, healthcare providers may use a lung resection to get tissue samples. These samples can help them diagnose cancer, tuberculosis or other lung infections, lung nodules, pulmonary fibrosis and other inflammatory lung diseases^[1]. The procedure may also be recommended for suppurative lesions (areas of infection producing pus), fungal infections, and congenital lung malformations such as congenital lobar emphysema or congenital cystic adenomatoid malformation^[5].

Types of Pulmonary Resection

There are several types of lung resection, categorized by how much lung tissue the surgeon removes. The type of resection your doctor recommends depends on the location and extent of the disease, as well as your overall health^[1].

Wedge resection involves removing a wedge-shaped section of lung tissue. This procedure removes less lung tissue than other types and is appropriate for small, localized areas of disease^[1][2]. A segmentectomy removes one to four portions of a lobe of your lung while preserving the rest^[1]. This procedure aims to remove the lung disease without taking out excess normal lung tissue^[15].

Lobectomy is the most common type of lung resection. In this procedure, the surgeon removes one complete lobe of your lung^[1][2]. A special type called a sleeve resection involves removing part of your lung and main bronchus (the large airway leading to the lung), then reattaching the main bronchus to the remaining, healthy lobe^[1]. This technique is often used for patients with locally advanced lung cancer that involves central airways or vascular structures^[9].

A bilobectomy removes two lobes of your right lung, while a pneumonectomy removes your entire lung^[1][2]. There is also lung volume reduction surgery, where a surgeon removes pockets in your lungs that contain trapped air, often used in patients with emphysema^[1].

Surgical Approaches

A surgeon can perform pulmonary resection using two main approaches: minimally invasive surgery or open surgery. The choice depends on several factors including the location and size of the area to be removed, your overall health, and the surgeon’s expertise^[1].

Minimally invasive surgery includes video-assisted thoracoscopic surgery (VATS) or robotic video-assisted thoracoscopic surgery (RVATS). With these approaches, your provider makes smaller incisions, typically 2 to 3 inches long, and uses instruments through a thoracoscope (a lighted tube with a camera on the end) or a robotic arm to perform the surgery^[1][2]. VATS is currently the standard approach for many patients with lung disease^[15].

Minimally invasive surgery offers several benefits compared to traditional open surgery. It results in less pain, smaller incisions, faster recovery, shorter hospital stays, and reduced risk of infection^[5]. The surgical robot’s miniaturized equipment is precise and flexible, and its enhanced imaging provides sharp, clear, three-dimensional views of the operating site^[5].

Open surgery, also called a thoracotomy, is more involved than minimally invasive surgery. A surgeon makes a larger incision, typically 8 to 10 inches long, in your side and spreads your ribs apart to access the lung^[1][2]. While this approach allows the surgeon direct access to the lung, it generally requires a longer recovery period compared to minimally invasive techniques.

Preparing for Surgery

Proper preparation for lung resection is important to reduce your risk of complications. Your healthcare provider will give you specific instructions on how to prepare, and following their directions closely is essential^[1].

Before your surgery, you need to tell your healthcare provider about all medications you take, including supplements, and if you have any implanted medical devices like a joint replacement, artificial heart valve, or pacemaker^[1]. You may need to stop taking certain medications or change your medication schedule, but never stop taking medications unless your provider tells you to^[1].

Preparation typically includes not eating or drinking anything for a certain amount of time before the procedure, usually after midnight the night before surgery^[7]. If you smoke, you should stop as this is an important step in preparing for surgery^[1]. You will need to arrange to spend several days at the hospital and have someone drive you home afterward^[1].

Your doctor may order various tests or imaging before the procedure to help plan the surgery. These can include blood tests, chest X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), tissue biopsy, bronchoscopy, or positron-emission tomography (PET) scans^[2]. It is also important to leave all jewelry at home, remove all makeup and nail polish, and wear comfortable clothing when you come to the hospital^[2].

What to Expect During the Procedure

A lung resection will typically take anywhere from 2 to 6 hours to complete, depending on your condition and the goals of the surgery^[2][4]. The procedure is performed in a cardiothoracic operating room under general anesthesia, which means you will be unconscious during the surgery^[4][7].

During the surgery, you will have a breathing tube placed in your throat to help you breathe. A nurse will start an intravenous (IV) line in your arm to administer medications and fluids^[2]. The surgeon will then make an incision on your side between your ribs to reach the lung. Once the diseased tissue is removed, along with any necessary lymph nodes and surrounding tissue, the surgeon will close the incision with stitches or staples^[1].

After the surgery, you will have drainage tubes coming out of your chest to drain fluids. These tubes are a normal part of the procedure and help remove excess fluid and air from the chest cavity^[8]. Your doctor will probably remove these tubes about one week after surgery^[8].

Recovery and Post-Operative Care

Recovery from lung resection is a gradual process that requires patience and careful attention to your healthcare team’s instructions. Most patients stay in the hospital for about 3 to 7 days following the procedure, depending on the type of surgery and individual progress^[5][7].

It is common to feel tired for 6 to 8 weeks after surgery^[8]. Your chest may hurt and be swollen for up to 6 weeks. It may ache or feel stiff for up to 3 months^[8]. For up to 3 months, you may also feel tightness, itching, numbness, or tingling around the incision^[8]. After surgery, you will probably feel short of breath. Your doctor, nurse, or respiratory therapist will teach you deep-breathing and coughing exercises to help your body get as much oxygen as possible^[8].

Managing pain is an important part of recovery. Your doctor will give you medicines to help with pain, and you should take them exactly as directed^[8]. The hospital will provide you with physical therapy if needed and will encourage you to sit in a chair and stand and walk within a day of your operation^[7].

During recovery at home, you should rest when you feel tired and try to walk each day, gradually increasing the amount^[8]. Walking helps boost blood flow and prevents pneumonia and constipation^[8]. However, you need to avoid strenuous activities such as bicycle riding, jogging, weight lifting, or aerobic exercise for 6 to 8 weeks, or until your doctor says it is okay^[8]. For the same period, avoid lifting anything over 2 kilograms (4.5 pounds)^[8].

You may have stitches or staples in the incision, which your doctor will take out 1 to 2 weeks after surgery^[8]. You may be able to take showers, but if you have a drain near your incision, follow your doctor’s instructions carefully. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay^[8].

You can eat your normal diet, but if your stomach is upset, try bland, low-fat foods^[8]. You may notice that your bowel movements are not regular right after surgery, which is common. Try to avoid constipation and straining with bowel movements^[8]. You will probably need to take 1 to 2 months off from work, depending on the type of work you do and how you feel^[8]. The time it takes to fully recover from lung resection can vary, but in most cases, it takes 6 to 12 months to regain lung function^[19].

Risks and Complications

Like any major surgery, pulmonary resection carries some risks and potential complications. The level of risk is relatively low for most patients, but it is important to understand what complications can occur^[4].

The development of postoperative pulmonary complications such as pneumonia, empyema, and atelectasis can occur, with rates as high as 10% in some series^[14]. These complications are associated with increased length of hospital stay, longer time in intensive care, and increased mortality^[14]. An air leak in the lung or the inability of your lung to fill normally can also occur after surgery^[4].

Other possible risks include infection or bleeding, injury to the lungs or the blood vessels in the lungs, and repeated fluid buildup in the lung^[4]. Some patients may experience discomfort or difficult breathing, though this can be managed by your doctor as you recover^[4]. Pain in the area of the incisions is common but can usually be managed with pain medications^[4].

Side effects from anesthesia, such as vomiting, sore throat, headache, or difficulty urinating, may also occur but are typically temporary^[4]. If you experience any concerning symptoms during recovery, such as fever, increased shortness of breath, chest pain, or signs of infection at the incision site, you should contact your healthcare provider immediately.