Surgical Procedures: Lobectomy

What is a lobectomy and how is it done?

A lobectomy is when part of your lung is removed. The lungs are two large organs in the chest cavity. The job of the lungs is to filter oxygen and move it into our blood. The lungs also protect us from harmful things like smoke, pollution, bacteria, and viruses by trapping them in mucus that is made by the lungs. This mucus is then removed from the body by coughing and/or swallowing

Each lung is made up of lobes or sections. The left lung has two lobes. The right has 3 lobes and is larger.

A lobectomy may be used to treat some cases of:

• Lung cancer.
• Tuberculosis (TB).
• Lung abscess.
• Fungal infection.
• Emphysema.
• Non-cancerous tumor.

There are two ways to do a lobectomy:

• Thoracotomy: An incision (cut) is made between two ribs, from the front of the chest around to the back. The lobe is removed through this incision.
• Video-Assisted Thoracic Surgery (VATS): Small incisions are made, where your surgeon will place a thorascope (tube with a camera attached). This tube lets the surgeon see inside your chest and is less invasive than having a thoracotomy.

What are the risks of a lobectomy?

There are risks and side effects to having a lobectomy. Risks and side effects may be:

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, not remember it and to manage pain. Reactions can include wheezing, rash, swelling, and low blood pressure).
• Bleeding.
• Infection.
• Damage to nearby organs like the heart, lungs, blood vessels, and nerves.
• An air leak in the lung leading to a pneumothorax (lung collapse).
• Empyema (collection of pus).
• Long-term, chronic pain.
• Bronchopleural fistula (abnormal connection of the bronchus and pleural space), which can lead to fluid in the chest.
• Air or gas in the chest.

What is recovery like?

Recovery from a lobectomy depends on the type of surgery you have had. A 5-10 day stay in the hospital may be needed. Often, a temporary chest tube(s) may be placed to remove extra fluid and/or air.

You will be told how to care for your incisions/drains and will be given any other instructions before leaving the hospital. You will be given instructions on oxygen administration if you need it.

Your medical team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention, and/or other conditions.

Your provider will talk with you about any restrictions you will have. In general:

• Take medications as prescribed. Be sure to speak with your healthcare team before taking medications that may increase the risk of bleeding, including aspirin.
• Keep your incisions clean and dry. Do incision care as you were taught.
• Speak with your healthcare team about showering/bathing. Often, you will be told to avoid rubbing the stitches when washing and patting the incision dry with a clean towel.
• Do breathing exercises as you were taught.
• Avoid heavy lifting until your healthcare team tells you it is safe to do so. Your provider will tell you how much weight you can lift.
• Avoid being exposed to people with colds, the flu, or other respiratory (lung) infections, chemical fumes, and/or environmental pollution.
• Avoid smoking and second-hand smoke. If you would like help quitting, speak to your provider.
• Use supplemental oxygen as directed.

What will I need at home?

• Thermometer to check for fever, which can be a sign of infection.
• Wound care, drain, and/or oxygen supplies, supplied to you either by the hospital, your surgeon’s office, or a homecare company.

When to call your healthcare team:

• Fever. Your care team will tell you at what temperature they should be called.
• Chills or any other signs of an infection.
• Pain, redness, swelling, drainage, or bleeding at your incision.
• Shortness of breath, coughing with or without green, yellow, or bloody mucous, having a hard time breathing, or pain with breathing.
• Chest pain (new or persistent).
• Nausea and/or vomiting.

Seek medical attention RIGHT AWAY if:

• You are coughing up blood (more than a teaspoon) or you have a lot of brown/bloody sputum.
• Dizziness, fainting, or passing out.
• Irregular heartbeat.
• Surgical bandage is soaked with blood or if your incision has come apart (separated), is swollen, red or leaking pus.
• Chest pain.
• Swelling, redness, warmth, tenderness, and/or pain in the leg or calf.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection, and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.