What Happens During a Lobectomy Procedure

Female doctor showing patient tablet with what happens during lung cancer surgery
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A lobectomy is a lung cancer surgery in which one lobe of a lung is removed. It removes more lung tissue than a wedge resection, but less than a pneumonectomy. Learn about what will happen when you arrive and during your surgery.

When You Arrive

When you arrive at the hospital, a nurse will take you to a preoperative room to prepare you for surgery. She will begin by making sure that you have followed any instructions for preparation for lung cancer surgery, such as refraining from eating after midnight, and taking (or not taking) medications per instruction.

She will then place an IV in your arm and have you change into a surgical gown. During this time you can usually have your loved one with you, and many surgery centers provide a calming environment prior to surgery.

You will likely talk to both your surgeon and anesthesiologist before going to the operating room. The anesthesiologist will talk about the anesthesia, and confirm that you don't have any allergies of concern to medication. Your surgeon may draw marks on your chest (with a Sharpie!) where incisions will be made. You will then be ready to head to the operating room.

During the Surgery

When you arrive in the operating room you will be transferred to the operating table. Your anesthesiologist will talk to you while administering the anesthesia, and most people fall asleep very rapidly. An endotracheal tube will be placed through your mouth into your windpipe and connected to a ventilator to breath for you during surgery. After surgery you may have a sore throat for a day or so due to the tube.

When you are asleep, the surgical team will cleanse the skin where the incisions will be made and apply surgical drapes.

During your lobectomy procedure, your surgeon will remove the lobe of your lung that is affected by lung cancer. Depending upon the type of lobectomy procedure your surgeon recommends, your cancer may be removed through an open incision or through the use of instruments inserted through smaller incisions. Here's what will happen during your procedure.

Surgical Approach

A lobectomy can be done in one of three ways, though the specific procedure often depends on the location of the tumor.

Open Lobectomy

In an open lobectomy, a long incision (a thoracotomy) will be made along your side following the curve of your ribs. The surgeon will spread your ribs and may remove a portion of a rib to gain access to your lung. The blood vessels (arteries and veins) and airways leading to the affected lobe are tied off, and the lobe is then removed. Prior to closing the incisions, your surgeon will insert a chest tube that will be left in place for a period of time. The chest tube allows excess blood and fluids to drain following surgery and will be removed when the drainage has stopped.

VATS Lobectomy (Video-Assisted Thoracoscopic Surgery)

During a VATS lobectomy, surgeons make several small incisions on your chest through which they can insert instruments and a small video camera (a thoracoscope). The camera projects an image onto a video screen that allows the surgeons to see the area they are working on. The blood vessels and airways to the involved lobe are tied off with the use of these instruments, and the lobe is removed through one of the incisions. Following removal of the lobe, surgeons may also biopsy or remove lymph nodes in the area near the tumor. A chest tube may or not be inserted into your chest following the surgery.

Sometimes surgeons encounter problems during a VATS lobectomy, such as bleeding or a tumor that cannot be adequately removed. In this case, the procedure may need to be converted to open lobectomy.

Robotic Lobectomy

A robotic lobectomy is similar to a VATS lobectomy, but the incisions and removal of lung tissue are done with the assistance of a robot. A robotic VATS lobectomy is only an option at some of the larger cancer centers and appears to be both safe and effective in clinical trials to date.

When Your Surgery Is Done

When your surgery has been completed, you will usually be taken to the recovery room for an hour or two. During this time you will be monitored closely for any bleeding or pain as you begin to wake up. Depending on how you do with surgery, as well as the surgeon's preference, you will then be taken to either the intensive care unit or a surgical floor. Most of the time your family will be allowed to see you and visit when you arrive back in your room, but this can vary between institutions.

Before Surgery

It's important to think carefully about a few things before your lobectomy procedure.

The Cancer Center

It's been found that hospitals that perform greater volumes of lung cancer surgery have better outcomes. For you, that might mean fewer complications or more effective removal of cancerous lung tissue.

Consider a Second Opinion

Strongly consider getting a second opinion. Not all surgeons are comfortable performing surgeries such as VATS lobectomy. While this approach cannot always be taken, it's worth considering (and finding a surgeon who performs this technique) as it is a less invasive procedure with an easier recovery most of the time. Your surgeon will not be upset if you request a second opinion, and in fact, most surgeons expect that patients will do this. You may wish to consider one of the larger National Cancer Institute-designated cancer centers for a second opinion, as some of these centers are more likely to have surgeons on staff who specialize in lung cancer surgery.

If You Smoke, Quit

Quit smoking if you smoke. We hesitate to write this because of the stigma of lung cancer, and many people who are diagnosed are former smokers or never smoked. But if you do smoke, quitting for even a short period of time can make a difference. For example, changes related to your heart begin to improve within 24 hours of your last puff. A 2017 study found that people who quit smoking before a lobectomy had fewer post-operative complications and were less likely to have to spend time in the intensive care unit.

Keep in Mind That Surgery Outcomes for Lung Cancer are Improving

When you let people know you are having lung cancer surgery, you may hear the all-too-common horror stories people seem inclined to share. If you do, you can let your well-meaning, but perhaps somewhat untactful friend know that the outcomes from lobectomy have improve greatly in recent years when it comes to the risk of major complications, the risk of post-operative deaths, and overall 3-year survival.

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  1. Lugg ST, Tikka T, Agostini PJ, et al. Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery. Journal of Cardiothoracic Surgery. 2017. 12(1):52. doi:10.1186/s13019-017-0614-4

  2. Oskarsdottir GN, Halldorsson H, Sigurdsson MI, et al. Lobectomy for non-small cell lung carcinoma: a nationwide study of short- and long-term survival. Acta Oncologica. 2017. 56(7):936-942. doi:10.1080/0284186X.2017.1304652

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