Lobectomy Complications and Prognosis

A lobectomy is a procedure in which a significant amount of lung tissue is removed. This treatment can be successful in treating lung cancer, especially early-stage lung cancer. However, a lobectomy is a type of major lung surgery, which means that there is a risk of complications.

Before deciding if a lobectomy is the best course of treatment for your condition, your doctor will review all your options, your overall health, and the possibility of short-term or long-term complications that may be related to lobectomy surgery.

Why Consider a Lobectomy?

When a tumor is found in one of the lungs, doctors may recommend surgery to completely remove the cancer. A lobectomy is the most common surgery used to treat early-stage non-small cell lung cancer. This is usually only an option for lung cancer at stage 1, stage 2, or stage 3A.

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 lungs are divided into sections called lobes. There are five lobes altogether: three that make up the right lung and two that make up the left lung (which is smaller to accommodate the heart on the lefts side of the chest). During a lobectomy, your doctor will completely remove one of these five lobes. As long as your remaining lobes are healthy, breathing shouldn't be a problem after the lobectomy.

This type of surgery has advantages over other surgical options, which include:

  • Wedge resection: wedge resection removes the tumor plus a wedge-shaped area of surrounding tissue. Less tissue is removed than in a lobectomy, but the procedure may also carry a higher risk of recurrence.
  • Pneumonectomy: A pneumonectomy is the removal of an entire lung. This is a significantly more involved procedure that carries higher risks.
  • Sleeve resection: A sleeve resection involves removing a lobe and some of the main bronchus (airway); it may be necessary in cases where tumors surround the airways.

Complications of removal of lung lobes may be less serious than complications related to these other types of surgeries.

Risk of Complications

After lung surgery, problems can occur. In some instances, more than half the people who undergo a lobectomy could suffer from some type of complication related to the procedure—ranging from something minor to a life-threatening issue. There are two types of lung-removal procedures, and the risk is significantly lower for the less invasive type: Video-Assisted Thoracoscopic Surgery (VATS).

During a VATS procedure, a surgeon makes just a few small incisions in the chest. Small instruments with a video camera are inserted into these incisions, allowing the tumor to be cut out and removed with minimal disruption to your chest area.

The other, more common, type of surgery offered is an open lobectomy or thoracotomy. During this surgery, a large incision is made across the chest and your ribs are spread apart so the surgeon can access the lungs and remove the tumor.

Estimates of the potential risks related to lobectomies vary widely. A review of major studies on the different procedures show the complications from VATS may occur between 6% and 34% of the time, and the rate may be as high as 58% for open lobectomy.

VATS procedures are not always possible or preferable to an open-chest procedure. Depending on where the tumor is located, it may not be able to be removed via video-assisted surgery. Also, surgeons may prefer to perform an open thoracotomy if it will ensure that all the cancerous tissue is removed. 

All surgeries also carry a risk of fatality. Thankfully, both forms of lobectomy surgery have low mortality rates. It's estimated that for 1% to 3% of those who have either an open thoracotomy or VATS, surgery-related problems could cause fatal complications. In these instances, pneumonia and respiratory failure are the most common causes of death.

Types of Complications

Advances in VATS and traditional open-chest surgery have been helping to improve the outcomes for lobectomy patients. However, you should be prepared for possible problems that can occur with surgery of the lungs.

Cardiac Arrhythmia

Atrial arrhythmia is an irregular heartbeat that begins in the upper chambers of the heart. Cardiac arrhythmias are common in patients who undergo general anesthesia and is one of the most common complications related to a lobectomy. The condition can result in a heart attack or stroke.

Persistent Air Leak

After surgery, there is sometimes a persistent air leak. This problem occurs in approximately 50% of people who have part of their lung tissue removed. Usually, the problem will resolve on its own within a few hours or days. In other circumstances, it requires a post-operative chest tube to be left in place longer than planned

Lung Collapse

When a lung collapses (known as atelectasis), the air sacs won't fill with air, so the lung cannot function. This is a major risk after surgery. It's often the result of prolonged use of a ventilator and the inability to cough while under anesthesia, which naturally clears the lungs.

Pneumonia

Atelectasis can often progress into more serious conditions, including pneumonia. This infection can be minor or lead to a life-threatening condition. Studies show that the risk for pneumonia after thoracic (chest) surgery is about 6%.

Ventilator Dependence

A need to be on a respirator for a prolonged period of time after surgery is a common concern for people having lung cancer surgery.  Prolonged ventilation may be required if you're dealing with another complication such as a post-operative infection.

Excessive Bleeding

Hemorrhaging, or excessive bleeding, after a lobectomy seems to occur in almost 3% of cases. You will need to go back into surgery to close up any areas that are not properly sutured.

Bronchopleural Fistula

A rare, but potentially fatal, complication, bronchopleural fistula is an abnormal passageway that develops between lungs' large airways and the space between the membranes that line the lungs. If this happens, you will be taken back into the operating room to correct the problem.

Blood Clots

Deep vein thrombosis (DVTs), blood clots in the legs, may travel to the lungs. This is known as pulmonary embolus and is one of the most serious complications of thoracic surgery. Your doctor will take precautions to avoid this problem, and you should take to heart any advice you are given to reduce your risk, which may include taking anticoagulant medications or following a specific schedule for when you are to be walking and when you are to be resting.

Long-Term Complications

Most complications of surgery are experienced in the days right after your operation, but some may persist or develop later on. One of the most difficult long-term issues that you may have to deal with is postpneumonectomy syndrome, or thoracotomy pain syndrome. These terms refer to an ongoing, uncomfortable sensation that you may feel following surgery. The problem is usually treated by using a combination of therapies such as opioids and never blockers.

Between 50% and 70% of people who undergo the removal of lung tissue feel pain for two or more months after surgery; more than 40% still have some degree of pain at one year after surgery; and, in all, 5% experience significant levels of pain.

VATS procedures are associated with lower levels of pain. In fact, studies have found that the recovery period following a VATS lobectomy is often shorter, with less post-operative pain than an open lobectomy.

Lobectomy Prognosis

The prognosis following a lobectomy depends on many factors. These include which lobe is removed and the stage of the cancer. Other factors that may influence the outcome of surgery are age, smoking habit, chronic obstructive pulmonary disease (COPD), and whether or not you are obese.

The overall five-year survival rate for lobectomy patients is approximately 70%—this is significantly higher than the survival rates for less invasive surgeries and non-surgical treatment options including radiation therapy. When a lobectomy is successfully done for early-stage lung cancer, it offers a chance for long-term survival without recurrence of cancer.

A lobectomy for non-small cell lung cancer may even result in a cure.

A Word from Verwell

While it's good to be aware of the percentage of people who have had complications during or after a lobectomy, it's important to realize that every person is different. Your risk may actually be much lower if your general health is good. Discuss your specific risks with your doctor, and see if there are things you can do before the surgery to help you reduce the odds of complications (such as losing weight or quitting smoking). It's also a good idea to seek a second opinion to ensure that no details are overlooked when it comes to planning your treatment.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Cancer Institute. Non-small cell lung cancer treatment: health professional version. Updated August 2018.

  2. Dziedzic D, Orlowski T. The Role of VATS in Lung Cancer Surgery: Current Status and Prospects for DevelopmentMinim Invasive Surg. 2015;2015:938430. doi:10.1155%2F2015%2F938430

  3. Lackey A, Donington JS. Surgical management of lung cancerSemin Intervent Radiol. 2013;30(2):133–140. doi:10.1055/s-0033-1342954

  4. Mueller MR, Marzluf BA. The anticipation and management of air leaks and residual spaces post lung resectionJ Thorac Dis. 2014;6(3):271-284. doi:10.3978/j.issn.2072-1439.2013.11.29

  5. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017;118(3):317-334. doi:10.1093/bja/aex002

  6. Ziarnik E, Grogan EL. Postlobectomy Early ComplicationsThorac Surg Clin. 2015;25(3):355–364. doi:10.1016/j.thorsurg.2015.04.003

  7. Wang Z, Pei C, Ma L, et al. Acute pulmonary embolism after pneumonectomy. J Thorac Dis. 2012;4(1):76-82.doi:10.3978%2Fj.issn.2072-1439.2011.10.02

  8. Bruce J, Quinlan J. Chronic Post Surgical PainRev Pain. 2011;5(3):23–29. doi:10.1177/204946371100500306

  9. Bryant A, Mundt R, Sandhu A et al. Stereotactic Body Radiation Therapy Versus Surgery for Early Lung Cancer Among US VeteransAnn Thorac Surg. 2018;105(2):425-431. doi:10.1016/j.athoracsur.2017.07.048

  10. American Cancer Society. Surgery for Non-Small Cell Lung Cancer. Updated October 1, 2019.