Lung surgery includes a variety of procedures used to diagnose or treat diseases of the lungs. Biopsies are performed to extract a small amount of tissue for diagnosis, resections remove a portion of lung tissue, and other surgeries are aimed at reducing the volume of the lungs, removing cancerous tumors, or improving lung function.
The type of lung surgery performed will depend upon the underlying disease or condition, as well as other factors.
- Pneumonectomy usually refers to the removal of a lung, or sometimes one or more lobes (sections containing lung tissue, air sacs, ducts, and respiratory bronchiole). It is most commonly indicated in certain forms and stages of lung cancer.
- Thoracotomy, or surgical incision of the chest wall, is used primarily as a diagnostic tool when other procedures have failed to provide adequate diagnostic information.
- Lobectomy is the term used to describe removal of one lobe of a lung. It is most commonly indicated for lung cancer, but may also be used for cystic fibrosis patients if other treatments have failed.
- Other surgical procedures include segmental resection or wedge resection. A resection is the removal of a part of the lung, often in order to remove a tumor. Wedge resection is removal of a wedge-shaped portion of lung tissue.
- Volume reduction surgery is a newer surgery used to help relieve shortness of breath and increase tolerance for exercise in patients with chronic obstructive pulmonary disease, such as emphysema.
- Other surgeries are continuously improved upon to make biopsy less invasive and surgery more effective, such as video-assisted lobectomy. Other purposes for lung surgery may include severe abscess, areas of long-term infection, or permanently enlarged or collapsed lung tissue.
Thoracotomy should not be performed on patients whose general health status will not tolerate major surgery. Any surgery carries with it risks associated with general anesthesia and possibility of infection. Patients whose risk for these complications outweighs benefit may not be considered candidates for lung surgery. Each individual patient's condition will be reviewed prior to the treatment decision.
Lung surgery procedures will vary depending on the underlying cause of the surgical test or intervention. A patient will be placed under general anesthesia during the surgery. An incision is made to examine the lungs. Diseased tissue is removed and may be sent for biopsy. Following the surgery, drainage tubes may be placed in the chest to drain fluids, blood, and air from the chest cavity. Tubes will most likely remain in place for one to two days, depending on the surgery and the patient's condition. The chest cavity, ribs, and skin are closed and the incision will be sutured. Hospital stay averages from three to 10 days.
Pneumonectomy consists of removal of all of one lung. It may often be indicated only when a lobectomy does not successfully remove the cancerous or damaged tissue. Thoracotomy consists of reaching the lung tissue through incision and obtaining tissue for a biopsy. The biopsy is used to diagnose or stage cancer, and thoracotomy may be avoided until other less invasive methods have failed. Volume reduction surgery involves incision and removal of those parts of the lung or lungs which are the most destroyed, in order to allow for full function of the remaining lung structure. This procedure is still being studied.
Lobectomy is performed in the same general manner as other lung surgeries, but will involve removal of an entire lobe of the lung. Most patients with Stage I or II non-small cell lung cancer will receive this treatment for their disease, or a less extensive resection. Lobectomy may only be performed if a wedge or segmental resection is ineffective, but is generally preferred as treatment for primary lung cancer in any patient who can tolerate the procedure. Wedge and segmental resections are still major surgery, but remove less tissue and may be the first choice for some patients, such as those with Stage I and Stage II non-small cell lung cancer. Patients who do not have enough pulmonary function to undergo a lobectomy will receive a wedge or segmental resection instead. This may lead to a higher recurrence rate of cancer. In general, the surgery method chosen will depend on specific circumstances and consideration of benefit versus risk.
Preparation for lung surgery is much like that for any major surgery. Patients will receive instructions from a physician concerning limit of food or water intake prior to the surgery, as well as risks and expected recovery. Patients should continue to follow treatment for the underlying condition, unless instructed otherwise by the physician, and should discuss medications and changes in condition with their physician prior to the surgery.
The chest tube inserted at the end of surgery will remain in place until the lung has fully expanded. Patients will be carefully monitored in the hospital for complications and infection. Deep breathing is recommended to help lessen the risk of pneumonia and infection. Breathing exercises will also help expand the lung. After discharge from the hospital, the patient may still receive some pain or infection-fighting medications and should recover within one to three months of the operation.
Risks of lung surgery follows those of any major surgery involving general anesthesia. These risks include reactions to anesthetics or medications, bleeding, infection, and problems restoring breathing. Lung surgery, in particular, offers the risk of pneumonia and blood clots. Thoracotomy, as a biopsy procedure, offers greater risk than most biopsy procedures.
Outcome for any lung surgery depends on many factors and the severity of disease. In general, the predicted benefits, which justified the surgery, are normal expected results. Thoracotomy results in a definitive diagnosis in more than 90% of patients. Volume reduction surgery has been shown to result in relief of some symptoms and improvement in quality of life for selected patients with severe emphysema and have shown short-term promise.
Mortality from lung surgery improves as procedures move from the more complete pneumonectomy to lobectomy, and the lowest rate for segmental resection.
American Cancer Society. 1599 Clifton Rd., NE, Atlanta, GA 30329-4251. (800) 227-2345. http://www.cancer.org.
American Lung Association. 1740 Broadway, New York, NY 10019. (800) 586-4872. http://www.lungusa.org.
National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. http://www.nhlbi.nih.gov.