Lung Resection

Overview

Advances in technology have made early identification of lung cancer possible for thousands of people who are at risk. This dangerous disease is usually curable if discovered in its early stages. Surgery, either alone or in conjunction with other cancer therapy, has the highest chance of stopping the disease from developing and spreading.

 

What is a Lung resection?

Lung resection is the surgical removal of all or part of the lung due to lung cancer or another type of lung illness. When a tumor is identified early, surgery can give a cure in certain cancer instances. The type of resection for cancer patients will be determined by the tumor's location, size, and type, as well as the patient's overall health prior to diagnosis.

 

Lung cancer surgery

Depending on the kind, location, and stage of their lung cancer, as well as other medical issues, certain people may be candidates for lung cancer surgery. Surgical attempts to treat lung cancer require removing the tumor as well as some surrounding lung tissue and frequently lymph nodes in the tumor's vicinity. When the disease is limited and unlikely to have spread, lung cancer surgery is regarded the best treatment. This includes non-small cell lung cancer and carcinoid tumors in their early stages.

 

Indications for Lung resection

Many disease processes, both malignant and metastatic, are susceptible to anatomic segmental excision.

Malignant - Segmental resection is appropriate in select patients with non-small cell lung cancer who have: 

• Poor pulmonary reserve or other contraindication for lobectomy
• Peripheral nodule with pure adenocarcinoma in situ (AIS) histology, greater than 50% ground-glass appearance on CT, or extended doubling time confirmed by radiologic monitoring. Segmentectomy should result in parenchymal margins of at least 2cm and sampling of relevant N1 and N2 lymph node stations.
• Metastatic - Resection of pulmonary metastases has been demonstrated to increase colon cancer survival. To preserve pulmonary reserve, excision of solitary or numerous lesions may be required.
• Nonmalignant - In congenital deformities (bronchial atresia, bronchiectasis, pulmonary arteriovenous malformation, and pulmonary sequestration), infectious processes (aspergilloma and nontuberculous mycobacterium), and other pulmonary diseases, segmentectomy has been described (bronchiectasis and inflammatory pseudotumors).

 

Different Types of Lung Surgeries

Depending on the location and size of your tumor, your NorthShore surgeon will prescribe one of many treatments to remove the abnormal growth, including VATS or standard open surgery. These surgical methods differ depending on how much tissue may be safely removed while still providing sustainable lung function and quality of life. They are as follows:

• Lobectomy: This treatment, which is the standard of care for lung cancer, entails removing the whole lobe of the lung that contains the malignant lesion. The quantity of tissue removed is around the size of your fist and accounts for about 15-20% of the total lung capacity.
• Wedge Resections: When lobectomy is not an option, this surgery is done to remove the nodule and a much lesser portion of normal lung tissue surrounding the lesion. The quantity of tissue removed is generally the size of your thumb and represents less than 5% of the total lung capacity.
• Segmentectomy: This surgical method is utilized for growths that are difficult to remove by wedge resection due to their position on the lung, or for patients who have low baseline lung function and are not candidates for lobectomy. The quantity of tissue removed is typically around 10% of the total lung capacity and is roughly the size of a half-fist.
• Pneumonectomy: Pneumonectomy, or the removal of a complete lung, is normally reserved for severe instances of lung cancer and can only be performed as a classic open surgery.
• Metastasectomy: For patients whose lung cancer began elsewhere in the body before spreading to the lungs, this operation often entails a wedge resection.

 

Preparation For Lung Resection 

Lung cancer screening programs will identify a large percentage of people. These programs are a significant tool for identifying and monitoring people at high risk for lung cancer in order to diagnose it at an early stage when curative therapy is still available. Adults aged 55 to 80 with a total 30-pack-year smoking history who presently smoke or have stopped within the last 15 years should receive an annual screening with low-dose CT. This problem is now being debated, with the possibility of reducing the smoking history to 20 pack-years and beginning screening at the age of 50.

All patients with suspected or confirmed lung cancer should be staged appropriately. CT chest and abdomen with contrast, smoking cessation counseling, pulmonary function tests, bronchoscopy (may be performed intraoperatively), fluorodeoxyglucose (FDG) positron emission tomography PET-CT scan, and lymph node examination are all standard evaluations.

Once the choice to proceed with lung resection has been reached, all patients must undergo respiratory testing to establish their capacity to endure the treatment. The mainstay is, as mentioned, pulmonary function testing, V/Q scan, and cardiac stress testing.

 

How you have your operation?

1. Open Thoracotomy Approach 

The patient is in the lateral decubitus posture, with the chest cavity hyperextended. The standard method is a posterolateral thoracotomy. Rib-spreaders are strategically positioned to aid with visualizing. Typically, single lung ventilation is used. The target anatomy is dissected, and resections are done using suitable staplers. 

    2. Video-Assisted Thoracoscopic Approach 

A typical segmentectomy comprises dissection in two planes [left upper segment, left basilar segment, right basilar segment]. Standard VATS method with the patient in lateral decubitus and thorax hyperextension. In the 4 or 5 interspace anterior to the latissimus dorsi, make a 3 to 4 cm incision. Examine the pleural cavity using the thoracoscope. This single incision can accommodate more tools, and adhesions should be split.

Identify the pulmonary artery and the upper segment branching for the segmentectomy. A vascular load stapler divides this. The venous supply is then identified. The venous drainage from the lingula must not be impaired during the left upper segmentectomy. The bronchus is then located and stapled off. A leak test should then be done. The parenchyma plane can then be dissected and the portion removed. A thoracostomy drain is often left in place after lung reexpansion, and closure is completed.

Atypical segmentectomy requires dissection in three dimensions and is more technically difficult. The best surgical technique must be chosen using preoperative imaging and must take into account individual surgeons' abilities.

    3. Robotic-Assisted VATS Approach 

The VATS technique is used for positioning, with port placement controlled by the targeted section. The number of ports differs between two popular techniques, 3 versus 4.

 

What to Expect?

General anesthesia is used for all lung procedures (VATS and open). VATS, also known as thoracoscopy, is performed through many tiny incisions made under the arm and between the ribs. The incisions are around 1 to 2 inches long. To get access to your lung and chest cavity, open surgery (thoracotomy) often necessitates a wide incision on the side of your chest and modest rib spreading.

The length of stay in the hospital varies, depending on your procedure:

• VATS wedge resections: 1 to 2 days on average
• VATS segmentectomy or lobectomy: 2 to 3 days on average
• Open lobectomy or pneumonectomy: 3 to 4 days on average

 

Following the treatment, your pain will be managed using one of many techniques, including a pump that distributes pain medication through your intravenous line on demand, a nurse who administers medicine through your intravenous line on demand, or oral medications. The physician will inject a long-acting anesthetic medicine straight into the area between your ribs during operation. This form of pain control has been shown to dramatically minimize post-operative pain.

If you live alone and are discharged from the hospital, you should make plans for someone to accompany you for the first few days. You will not be allowed to drive until you are no longer using pain relievers. Some patients may require home oxygen for a short period of time, often 4 to 6 weeks.

Your Recovery

Lung resection is a surgical procedure that removes part or all of your lung. It is employed in the treatment of a damaged or diseased lung. It is normal to feel weary for 6 to 8 weeks following surgery. For up to 6 weeks, your chest may ache and swell. It might hurt or feel stiff for up to three months. You may also have stiffness, itching, numbness, or tingling around the cut (incision) made by the doctor for up to 3 months. Your doctor will prescribe pain relievers for you.

The incision may include stitches or staples. These will be removed by your doctor one to two weeks following your procedure. One or more tubes may be coming out of your chest to remove fluids. Your doctor will most likely remove them approximately a week following surgery.

You will most likely feel out of breath after surgery. To assist your body obtain as much oxygen as possible, your doctor, nurse, or respiratory therapist will teach you deep breathing and coughing techniques. At first, you may need to supplement your oxygen supply using a mask or a plastic tube inserted into your nostrils (nasal cannula).

This care sheet will give you an estimate of how long it will take you to recuperate. However, everyone recovers at their own speed. Follow the actions outlined below to get better as soon as possible.

 

How can you care for yourself at home?

Activity

• When you're exhausted, take a break. Getting adequate sleep can assist you in recovering.
• Make an effort to walk every day. Begin by walking a bit more than you did the previous day. Increase your walking distance gradually. Walking increases blood flow and aids in the prevention of pneumonia and constipation.
• For 6 to 8 weeks, or until your doctor thinks it's safe, avoid intense activities like biking, running, weight lifting, or aerobic activity. Avoid swimming, tennis, golf, and other sports that might strain your arm and shoulder muscles for 6 to 8 weeks.
• Avoid lifting anything more than 2 kilos (4.5 pounds) or causing strain for 6 to 8 weeks. A youngster, hefty shopping bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner are all examples.
• You might be able to shower (unless you have a drain near your incision). If you have a drain, make sure you empty and care for it according to your doctor's recommendations. Do not bathe for the first two weeks, or until your doctor says it is safe.
• Ask your doctor when you can drive again.
• You will most likely need to take 1 to 2 months off work. It depends on the nature of your employment and how you feel.
• Do not fly in an airplane or dive deep (like in scuba diving) until your doctor gives you the all-clear. Avoid any circumstance where the air pressure is high.

 

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Ask your doctor how much fluid you should drink.
• You may notice that your bowel motions are irregular immediately following surgery. This is rather frequent. Constipation and bowel straining should be avoided. You should consider taking a fiber supplement every day. If you haven't had a bowel movement in a few days, consult your doctor about using a moderate laxative.

 

Medicines

• Your doctor will inform you when and if you may resume taking your medications. You will also be given information on how to take any new medications.
• If you use aspirin or another blood thinner, see your doctor about when and if you should resume taking it. Make sure you understand everything your doctor wants you to do.

 

• Be safe with medicines. Take pain medicines exactly as directed.

• • • If your doctor ordered pain medication, use it exactly as directed.
    • Whether you do not have a prescription for pain medication, ask your doctor if you may use an over-the-counter medication instead.

 

• If you think your pain medicine is making you sick to your stomach:

• Take your medicine after meals (unless your doctor has told you not to).
• Ask your doctor for a different pain medicine.

 

• Take antibiotics exactly as advised by your doctor. Do not stop taking them simply because you are feeling better. You must complete the entire course of antibiotics.

 

Incision care

• If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
• Every day, wash the area with warm, soapy water and pat it dry. Other cleaning agents, such as hydrogen peroxide, might impede wound healing. If the wound weeps or scrapes against clothing, wrap it with a gauze bandage. Every day, change the bandage.
• Keep the area clean and dry.
• Wear clean, loose clothing over your incision.

 

Exercise

• Cough and conduct deep breathing exercises as directed by your doctor, nurse, or respiratory therapist to help keep your lungs clean.
• Your doctor may give you an incentive spirometer to take home. This is a gadget that assists you in practicing deep breathing. This can aid in the health of your lungs.
• In order to keep the muscles near your chest strong and flexible, see your doctor about shoulder workouts.

 

Other instructions

• Do not smoke or allow others to smoke around you. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Try to avoid being around people who have a cold, influenza (flu), or other illnesses.

 

Complications

Pulmonary edema, pneumonia, adult respiratory distress syndrome, bronchial dehiscence, bronchopleural fistula, lobar torsion, hemothorax, and chylothorax are early postoperative consequences of lung resection. Bronchial stenosis, empyema, postpneumonectomy syndrome, stump thrombus, and esophagogastric fistula are late postoperative consequences of lung resection.

A greater incidence of cancer recurrence and insufficient lymph node sampling are related with segmentectomy, which should be mentioned with any patient seeking sublobar resection for malignant illness.

 

Conclusion 

Lung resection is the surgical removal of all or part of the lung due to lung cancer or another lung ailment. Lung cancer surgery is a major procedure that requires you to be in good health. Before surgery, your doctor will arrange for tests to see how well your lungs and heart are functioning.