From the Guidelines
Lobectomy of the lung is a major surgical procedure that can be expected to have a significant impact on a patient's quality of life, with a morbidity rate ranging from 10 to 45% and a mortality rate of 1 to 2%. The procedure involves the surgical removal of one lobe of the lung, typically to treat lung cancer, severe infections, or other lung diseases. Before surgery, patients will undergo thorough evaluation including pulmonary function tests, imaging studies, and possibly a biopsy, as recommended by the guidelines on enhanced recovery after pulmonary lobectomy 1.
Preoperative Evaluation
The preoperative evaluation is crucial in determining the patient's suitability for surgery and in identifying potential risks and complications. This evaluation should include a thorough medical history, physical examination, and diagnostic tests such as pulmonary function tests and imaging studies. The patient's overall health and fitness for surgery should be assessed, and any potential risks or complications should be identified and addressed.
Surgical Procedure
The procedure is performed under general anesthesia and may be done through traditional open surgery (thoracotomy) or minimally invasive techniques (video-assisted thoracoscopic surgery or VATS). The choice of surgical approach will depend on the individual patient's circumstances and the surgeon's preference. VATS has been shown to be associated with fewer complications, lower estimated blood loss or transfusion rate, and shorter hospital length of stay compared to open lobectomy 1.
Postoperative Care
Post-operative care includes pain management with medications like opioids initially, transitioning to acetaminophen or NSAIDs; chest tubes to drain fluid and air for 2-4 days; breathing exercises with an incentive spirometer every hour while awake; and gradual physical activity starting with walking. Patients can expect to stay in the hospital for 3-7 days after surgery. The guidelines on enhanced recovery after pulmonary lobectomy recommend a multidisciplinary approach to postoperative care, involving surgeons, anesthetists, and intensive care physicians 1.
Recovery and Follow-up
Recovery at home takes 4-8 weeks, with restrictions on heavy lifting (nothing over 10 pounds) for about 6 weeks. Common complications include pain, pneumonia, air leaks, and bleeding. Follow-up appointments will be scheduled to monitor the patient's recovery, with the first visit typically 1-2 weeks after discharge. Most patients experience improved quality of life after recovery as the diseased portion of lung is removed, though they may notice some reduction in exercise capacity depending on their pre-surgery lung function.
Key Considerations
- The patient's overall health and fitness for surgery should be carefully assessed before undergoing a lobectomy.
- The choice of surgical approach (VATS or open lobectomy) should be individualized based on the patient's circumstances and the surgeon's preference.
- A multidisciplinary approach to postoperative care is recommended to minimize complications and improve patient outcomes.
- Patients should be closely monitored for potential complications, including pain, pneumonia, air leaks, and bleeding, and should receive follow-up care to ensure a smooth recovery.
From the Research
Expected Outcomes of Lobectomy
- Lobectomy is a standard treatment for early-stage lung cancer, and it provides the best survival rates for patients with stage I lung cancer, regardless of age 2.
- The procedure can be performed using minimally invasive techniques, such as thoracoscopic or robotic-assisted lobectomy, which offer advantages over traditional thoracotomy approaches, including less pain, shorter hospitalization, and fewer complications 3.
- However, lobectomy may not be suitable for all patients, particularly those with respiratory compromise, and alternative treatments, such as segmentectomy, may be considered to conserve lung function 4.
Potential Complications and Risks
- Longer operative durations for lobectomy are associated with increased postoperative morbidity, including pneumonia, atelectasis, and unexpected intensive care unit admission, as well as longer hospital stays 5.
- Patients with chronic obstructive pulmonary disease (COPD) may experience a slower recovery of pulmonary function after lobectomy, with significant reductions in forced expiratory volume in 1 second (FEV1%) persisting up to 1 month after surgery 6.
- The type of lobectomy performed (e.g., upper or lower lobectomy) can also affect postoperative pulmonary function and recovery time, with lower lobectomy patients experiencing a more significant decrease in forced vital capacity (FVC%) up to 6 months after surgery 6.
Postoperative Recovery
- Pulmonary function tests (PFTs) can be used to evaluate the serial changes in pulmonary function after lobectomy and predict postoperative pulmonary function changes and recovery time 6.
- The recovery time for pulmonary function after lobectomy can vary depending on the type of lobectomy performed and the presence of COPD, with some patients experiencing a faster recovery than others 6.
- Accurate prediction of postoperative pulmonary function changes and recovery time can help inform patient management and optimize postoperative care 6.