Lobectomy Complications and Prognosis

In lung cancer treatment, a lobectomy is a surgical procedure in which one of the five lobes of the lungs is removed. This intervention can be successful in treating the disease, especially early-stage lung cancer. And as long as your remaining lobes are healthy, breathing shouldn't be a problem after the procedure. However, a lobectomy is a major lung surgery. While it can be life-saving, it does come with a risk of complications that must be carefully considered.

Before deciding to proceed with a lobectomy, your healthcare provider will review all your treatment options, your overall health, and the possibility of you experiencing short-term or long-term complications related to this procedure.

Risk of Complications

Lobectomy has advantages over other surgical options for lung cancer. Among them: fewer serious complications.

For example, whereas a lobectomy removes one lobe of the lungs, a sleeve resection removes a lobe and some of the main bronchus (airway). A pneumonectomy removes the entire lung, rather than a lobe. The extent of these procedures alone makes them riskier than a lobectomy.

That is not to say that a lobectomy is not without the potential for complications. In fact, 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.

The surgical technique matters, as risks are lower when the less invasive option—video-assisted thoracoscopic surgery (VATS)—is used.

*Estimates of the potential risks related to lobectomies vary widely. Data based on a review of major studies on the different techniques.

However, VATS procedures are not always possible or preferable to an open-chest procedure. Depending on where the tumor is located, it may not be accessible for removal via video-assisted surgery.

Also, your surgeon may determine that an open thoracotomy provides a better chance of ensuring that all the cancerous tissue is removed.

Types of Complications

Advances in VATS and traditional open-chest surgery have helped to improve the outcomes of lobectomy. If you are having this procedure, you should be prepared for possible problems that can occur.

Most complications of surgery begin to show signs in the days right after your operation, but some may persist or develop later on.

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 this 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, an air leak can form. This problem is usually transient and self-limited and 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 an uncommon, but serious, risk after surgery. It's often the result of prolonged use of a ventilator and the inability to cough (and, therefore, naturally clear the lungs) while under anesthesia.

Pneumonia

Atelectasis can progress into more serious conditions, including pneumonia. This infection can be minor or lead to a life-threatening situation. 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 concern for people having lung cancer surgery.  Prolonged ventilation may be required if you're dealing with another complication from your lobectomy, such as a post-operative infection.

Excessive Bleeding

Hemorrhaging, or excessive bleeding, after a lobectomy seems to occur in almost 3% of cases. If this happens to you, you may need to go back into surgery for control of bleeding.

Bronchopleural Fistula

A rare, but potentially fatal complication, bronchopleural fistula is an abnormal passageway that develops between large airways of the lungs and the spaces between the membranes that line the lungs. You will be taken back into the operating room to correct the problem if it occurs.

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 potential complications of thoracic surgery.

Your healthcare provider will take precautions to avoid this problem, and you should follow any advice you are given to reduce your risk, which may include taking anticoagulant medications or following a specific schedule for walking and resting.

Post-Operative 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.

When pain does occur, it's usually treated by using a combination of therapies such as opioids and interventional pain control procedures.

Chronic Pain

One of the most difficult long-term issues that you may have to deal with is postpneumonectomy syndrome, or thoracotomy pain syndrome.

This is characterized by ongoing chest pain, breathing discomfort, burning sensations, and/or pain with movement post-surgery.

Death

All surgeries also carry a risk of fatality. Thankfully, both forms of lobectomy surgery have low mortality rates.

It's estimated that surgery-related problems could cause fatal complications in 1% to 3% of those who have had either an open thoracotomy or VATS. In these instances, pneumonia and respiratory failure are the most common causes of death.

Lobectomy Prognosis

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

Lobectomy can improve survival, and sometimes this treatment is combined with 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 Verywell

While it's good to be aware of the possibility of complications from a lobectomy, it's important to realize that every person is different. Your risk may actually be much lower than average if your general health is good.

Discuss your specific risks with your healthcare provider (e.g., lifestyle, family history, chronic conditions), 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.