An Overview of Lobectomy as a Treatment for Lung Cancer

A lobectomy is a one type of lung cancer surgery in which one lobe of a lung is removed. (The right lung has three lobes, and the left lung has two lobes.) A lobectomy is also occasionally performed for other conditions, such as tuberculosis, severe COPD, or trauma that interrupts major blood vessels near the lungs. The procedure can be done either through an open thoractomy or through video-assisted thoracoscopic surgery. Learn about the preparation and recovery, possible complications, and prognosis of this procedure.

Types of Lobectomy
Verywell / Hilary Allison

Types of Lung Cancer Surgery

How do doctors decide that a lobectomy is the best type of lung cancer surgery for you? The type of lung cancer surgery your doctor recommends will depend on several factors, including:

  • The location of your tumor
  • The size of your tumor
  • Whether or not your tumor has spread to nearby tissues
  • Your general state of health
  • How well your lungs are functioning prior to surgery

A lobectomy is most commonly performed for a non-small cell lung cancers in which the tumor is confined to a single lobe. It is less invasive and conserves more lung function that a pneumonectomy, a procedure that involves removing an entire lung. In contrast, it is somewhat more extensive than a wedge resection, a surgery which removes the tumor and a small amount of surrounding tissue.

Types of Lobectomy

A lobe of your lung can be removed by a few different methods. Your surgeon will recommend one of these based upon both the characteristics of your particular cancer and how comfortable he is with each of the procedures:

  • Open lobectomy: In an open lobectomy, a lobe of the lungs is removed through a long incision on the side of the chest (thoracotomy).
  • VATS (video-assisted thoracoscopic surgery) lobectomy: In this procedure, a lobe of the lung is removed through a few small incisions in the chest with the assistance of instruments and a camera. A VATS lobectomy may be considered for stage 1 lung cancer with fairly small tumors (usually less than 3 to 4 cm). When a VATS lobectomy is possible, it may result in fewer complications than an open lobectomy.
  • RATS (robot-assisted thoracoscopic surgery): Similar to VATS but performed with robots, RATS also appears to result in fewer complications and shorter hospitalizations after a lobectomy, but controversy remains over whether survival is truly comparable.

VATS vs Open Lobectomy

How do you and your doctor choose between an open lobectomy and a VATS lobectomy, and what is the difference in recovery between these procedures?

Studies have found that the recovery period following a VATS lobectomy is often shorter, with less post-operative pain than an open lobectomy. ​Post-thoracotomy pain syndrome (also called postpneumonectomy syndrome) is a condition of persistent chest pain occurring months to years after lung cancer surgery and appears to affect roughly 50 percent of people having these surgeries to some degree. While we do not have studies looking at precisely this concern, it's likely that the VATS procedure will result in much less chronic pain as well.

Despite a more rapid recovery, there are times when VATS is not possible. The location of some tumors makes it very difficult to perform VATS, and in these cases, an open lobectomy might be both safer and more likely to remove the whole tumor.

Not all surgeons are comfortable performing VATS and this could play a role in the decision. Make sure to ask why an open lobectomy is recommended if this is the only choice you are given. You may wish to get a second opinion from a surgeon who is comfortable performing VATS, but keep in mind that even the best surgeons will not perform VATS if the location of a tumor suggests that an open lobectomy may result in a better outcome. There is some controversy over whether VATS procedures are becoming the standard of care, but much of the concern lies in the experience of the surgeons performing the procedure. For early-stage lung cancer, a VATS lobectomy is often the ideal approach, but with locally advanced lung cancers, it's likely that the experience of the surgeon becomes much more important in the outcome.

Another reason why a second opinion may be important with lung cancer is that studies show that the outcomes of people who have lung cancer surgery at centers which perform larger volumes of these surgeries tend to be better. In general, the likelihood of a good outcome with lung cancer tends to be better at larger cancer centers and teaching hospitals than smaller community hospitals. Many surgeons recommend getting a second opinion at one of the larger National Cancer Institute designated cancer centers.


It's important to take some time to learn how to prepare for lung cancer surgery. Prior to your lobectomy, your doctor will want to make sure you are as healthy as possible. She will also want to know that you will be able to breathe comfortably after a lobe of your lung is removed. In addition to a careful history and physical and blood tests, breathing tests (pulmonary function tests) will be done to check your lung function prior to surgery. Depending on your age and physical condition, she may recommend tests to check your heart as well.

Your doctor will carefully review all of your medications during your pre-operative visit and may recommend stopping some of your medicines for a period of time prior to surgery. It is helpful if you bring along the bottles containing any prescription and non-prescription medications, as well as any supplements that you use. Some dietary supplements can increase bleeding time and need to be stopped well in advance of surgery.

If you smoke, your surgeon will strongly recommend that you quit as soon as possible. Quitting smoking before surgery can reduce your risk of complications, improve wound healing, and increases the chance that your surgery will be successful. Increasing the success of lung cancer surgery is only one of the benefits of smoking cessation after a diagnosis of cancer.


A lobectomy is performed in the operating room after you are given a general anesthetic. There are two major lobectomy procedures that are often done to remove a lobe of the lung. In an open lobectomy, a lobe of the lung is removed through a long incision along the side of the chest. In a VATS lobectomy, a lobe is removed with the use of a camera and special instruments through several smaller incisions in the chest.

Before closing the incision(s), the surgeon will insert a chest tube into the surgical area to allow excess fluid and air to drain outside of the chest for a period of time.


Following your lobectomy, you will be monitored in the intensive care unit (ICU) for a day or so before going to a regular hospital room. A respiratory therapist will work with you, asking you to take deep breaths and breathe into an incentive spirometer. The nursing staff will help you get up and move about as soon as you are able. Barring complications, most people stay in the hospital between 4 days and 7 days, depending on the type of lobectomy that was done.


A lobectomy is a major surgical procedure, and surgical complications are not uncommon. Your doctor will discuss these with you prior to surgery. Some potential complications may include:

  • Prolonged air leak, requiring the chest tube to be left in place longer than 3 days to 4 days. This is the most common complication.
  • Infections, such as pneumonia.
  • Bleeding.
  • Heart problems, such as a heart attack or irregular heart rhythms.
  • Blood clots in the legs (DVTs) that may travel to the lungs (pulmonary embolus.)
  • Post-thoracotomy pain syndrome. Pain which persists after a lobectomy can be frustrating, but more is being done to try to make a difference. It is more likely to occur after an open lobectomy than a VATS procedure.


The prognosis following a lobectomy depends on many different factors. Some of these include the stage of your lung cancer—that is, how far it has spread—as well as your general health and whether you have any other lung problems in addition to lung cancer.

The overall mortality (risk of death) with a lobectomy is less than three percent, yet many people do have temporary complications such as an air leak.

When a lobectomy is successfully done for early stage lung cancer, it offers a chance for long-term survival without recurrence of cancer. Depending on characteristics of your cancer, your oncologist may recommend adjuvant chemotherapy following surgery to reduce the risk of recurrence.

An option that is not pursued enough after lung cancer surgery is pulmonary rehabilitation. Pulmonary rehabilitation for lung cancer has only recently been instituted at some cancer centers but appears to help with symptoms of shortness of breath as well as other symptoms.

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