Procedure-Lobectomy

Procedure definition

A lobectomy removes one lobe of the lung (there are three in the right lung, two in the left). It’s the standard operation for most early-stage non-small cell lung cancers and certain benign conditions like bronchiectasis or large cysts.

The goal is to remove the tumor along with nearby lymph nodes while preserving as much healthy lung as possible.

Lobectomies can be performed three ways:
• VATS (Video-Assisted Thoracoscopic Surgery): small incisions with a camera and instruments—now the most common approach.
• Robotic lobectomy: similar to VATS but with robotic instruments offering greater precision.
• Open thoracotomy: traditional approach with a larger incision between ribs, used for complex cases.

The operation typically lasts 2–4 hours, and part of a rib may be spread or partially removed to access the lung in open surgery.

Why it’s done

The most frequent reason is lung cancer confined to a single lobe. Removing that lobe offers the best chance for cure while maintaining breathing capacity. Other indications include localized infections, benign tumors, or damaged lung segments that impair overall function.

Modern imaging and pulmonary testing ensure patients have enough lung reserve to tolerate surgery. Minimally invasive techniques have made lobectomy possible for many older or previously inoperable patients, improving both survival and quality of life.

Risks & complications

Lobectomy is major chest surgery, so risks depend on age, smoking history, and lung function.

Overall complication rate: 15–35%.
Mortality: 1–3% elective cases.

Specific complications include:
• Prolonged air leak: 8–15%.
• Atrial fibrillation (irregular heartbeat): 10–20%.
• Pneumonia: 4–10%.
• Bleeding needing reoperation: 2–4%.
• Respiratory failure or need for temporary ventilator: 2–5%.
• Wound infection: 1–3%.
• Death: <3% in modern series.

Complication rates are notably lower with VATS or robotic approaches, which also shorten hospital stay and improve pain control. Smoking cessation at least 4 weeks before surgery markedly lowers complications.

Recovery

Hospital stay: 3–5 days (longer for open thoracotomy). Chest tubes remain for 1–3 days to drain air and fluid.

Pain control: Managed with nerve blocks, epidural, or oral medications. Early walking and breathing exercises are critical to prevent pneumonia.

Activity: Gentle activity starts within days. Driving and desk work: ~2–3 weeks. Full recovery: 6–8 weeks (minimally invasive) or 8–12 weeks (open). Pulmonary rehabilitation is often prescribed to rebuild endurance.

Long-term: Most patients regain normal breathing for everyday tasks. Regular CT scans monitor for cancer recurrence if applicable.

Surgeon types

Performed by Cardiothoracic (Thoracic) Surgeons, often specializing in lung cancer surgery. Centers performing >100 thoracic resections per year have significantly better outcomes.

Citations

1. Society of Thoracic Surgeons (STS): Outcomes Database summary (mortality 1–2%).
2. Annals of Thoracic Surgery (2020): Air leak 8–15%, AF 10–20%.
3. NIH MedlinePlus: “Lobectomy—Lung Surgery.”
4. JAMA Surgery (2019): Robotic vs. open—shorter stay and fewer complications.
5. NCCN Guidelines: Early-stage NSCLC surgical standards.