Pulmonary Lobectomy

There are three main types of lung cancer:

Non Small Cell Lung Carcinoma (NSCC) accounts for 85% of all lung cancer cases. Squamous cell carcinoma, adeno carcinoma, and large cell carcinoma are all sub-types of this type of cancer. NSCC can be surgically removed

Small Cell Lung Cancer accounts for about 10%-15% of lung cancer cases. This type of cancer tends to spread very quickly and is often inoperable.
Lung Carcinoid Tumor. Primary Lung Cancer originates in the lung tissue, while secondary lung cancer spreads into the lungs from other parts of the body, forming a metastatic tumor.

About 30% of lung cancer cases are diagnosed early, enabling surgical removal of the tumor (usually for stage I or II, but in some cases, surgery may be an option for stage III as well). In advanced cases, when cancer has already spread to other parts of the body, radiation therapy is typically used along with chemotherapy.

The type and extent of the surgical procedure will depend on the tumor type, size, and location.
The three main types of surgery are:

1. Wedge Resection which involves the removal of a small segment of the lung (not a very common procedure). Indicated in cases when the lung does not function properly.
2. Lobectomy – removal of one lobe of the lung.
3. Pneumonectomy – removal of the entire lung.

Hundreds of lobectomy procedures are performed in Israel each year. Most of them are related to lung cancer, however in some cases such procedures can also be indicated for other types of pulmonary diseases, chest injuries, or severe infections. If the surgery is performed in the early stages of cancer, the most likely outcome is a complete recovery.

At Cardiovascular Surgery Unit, a lobe of the lung is removed using the thoracoscopic (minimally invasive) technique which does not require the spreading of the ribs.
The method that we use is called Video Assisted Thoracoscopic Surgery (VATS). This minimally invasive surgery lasts 2-3 hours and is performed on the side of the chest. The surgeon makes three incisions, through which the camera and surgical instruments are inserted. The surgeon identifies the affected lobe of the lung, ligates the feeder vessels and removes the lobe from the patient’s body. Along with the affected lobe, the surgeon also removes the surrounding lymph nodes to evaluate for possible metastases. In some cases, express biopsy is performed as well, to assess whether the tumor has been removed completely, and provide information on the type of cancer.
It should be pointed out that open surgeries are technically easier to perform; however, multiple studies have shown that severe pain experienced by the patient during and after the surgery may actually lead to a reduction in success rates. This is why most lung resection procedures are performed at Tel Aviv Sourasky Medical Center using a minimally invasive technique, “through the keyhole,” while the open surgery technique is reserved for the cases where there is no other option.

After the anesthetic has worn off, patients are usually able to breath unassisted. In some cases, a short-term artificial lung ventilation may be required. Most patients will wear an oxygen mask allowing them to breathe more comfortably.
The patient usually remains in hospital for 3-5 days after surgery. For a few days after the surgery, the patient may feel weak, suffer from pain, and may have difficulty breathing.

Most patients undergo daily chest X-ray procedures, enabling physicians to control the healing process and make sure that the lungs function normally.

The recovery period following the surgery usually lasts 2-3 weeks.
At the end of hospital stay, special exercises will be recommended to the patient (rehabilitation exercises and physiotherapy) to speed up the recovery.
Following the surgery, the patient will be referred to the oncology division for the subsequent therapy (usually chemotherapy).
Two weeks after the surgery, the patient will be invited for a check-up with the operating surgeon.