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Lobectomy

Lobectomy is a surgical procedure to remove a section of the lungs, called a lobe. The right lung has three lobes—upper lobe, middle lobe, and lower lobe. The left lung has two lobes—the upper lobe and lower lobe. In the case of lung cancer, the affected lobe is removed as well as lymph nodes in the chest so they can be examined in the laboratory for the presence of cancer cells.

Lobectomy is the most common procedure to treat lung cancer, especially in its early stages, to prevent the disease from spreading to other parts of the body. This is also the preferred procedure for masses in the lungs, tuberculosis, lung abscess, emphysema, and fungal infection in the lungs.

Preparing for the Procedure

It is important that your health and disease are assessed before the procedure. You will be given all the information about your disease and the treatments offered for the most effective treatment planning. Your surgeon will explain your condition, the reason for surgery, all the risks involved, and the benefits of surgery. Furthermore, you will have to do the following:

1.    Before the procedure you will undergo a physical examination and laboratory tests, such as lung function test, and the doctor may recommend that you undergo physical therapy and practice coughing and breathing.

2.    If you have a history of excessive bleeding or abnormal bleeding, or if you or a family member have bruises all over the body, please let your doctor know.

3.    Please inform the medical team about any allergies you have to medications, food, and chemicals/substances. Also, let them know if you have any implanted electrical devices.

4.    You will need to stop certain medications for 5-7 days before the procedure, such as blood thinners. Please let your doctor know about all medication and supplements you are taking.

5.    You will be asked to fast for at least 8 hours before the procedure or as recommended by the doctor.

6.    Avoid drinking and smoking cigarettes for at least 1 week before the procedure.

7.    The area that will be operated on will be shaved and cleaned before the procedure.

8.    You will be given consent forms to sign before the procedure. Please make sure you read all documents before signing them.

9.    On the day of the procedure, please bring all your current medication to the hospital.

The procedure takes between 2-4 hours. An intravenous line will be administered to deliver fluids and medications. The anesthesiologist will talk to you about the general anesthesia that will be used during the procedure and how you should behave after. Lobectomy is an open surgery with an incision made in the side of the body, measuring approximately 20 centimeters. The surgeon will clamp arteries, veins, and bronchi before removing the affected lobe. One or more drains will be placed in the chest cavity to drain fluids before the incision is closed.

After surgery, you will be moved to an Intensive Care Unit (ICU) where you can be closely monitored. If the breathing tube given to you during surgery remains in place, you will not be able to talk. You will likely have drains coming out of your chest to remove air, blood, and other fluids from the chest cavity. Your doctor will remove these when appropriate. Intravenous (IV) lines give you fluid and medications. Monitors record your heartbeat and the amount of oxygen in your blood. You may spend 1-2 days or more in an Intensive Care Unit (ICU) until your symptoms are stable. After that, you will be moved to a regular hospital room.

You will experience pain for 2-3 days after the procedure, after which pain should improve gradually. You will be given pain medication to manage your discomfort. Practice breathing and move your body while you are in the bed. Get out of bed as soon as you can and walk to strengthen your lungs. How long you stay in hospital will depend on your condition, but most patients are in hospital for at least 1 week.

The severity of complications will depend on the patient’s health, but possible complications include:

  • Excessive bleeding
  • Infection
  • Collapsed lung
  • Injury to the bronchi or tissues of the lungs, causing air or fluid to fill up the chest cavity or the pleural space


Please let your doctor know immediately if you experience any of the following after the procedure:

  • Difficulty breathing, abnormal fatigue, pain when breathing
  • Fever higher than 38 degrees Celsius
  • Severe redness or swelling of the incision
  • Bleeding or seeping of fluid from the incision
  • Acute and severe chest pain
  • Coughing or worsening cough, coughing blood, or coughing up green or yellow sputum
  • Confusion or altered consciousness

You will need to recover at home for 2-4 weeks. If you have any questions, please talk to your doctor or medical team.

·        Activity. Avoid activities that involve pulling or pushing, lifting heavy objects, and other strenuous activity. Avoid driving for 2-4 weeks as this can affect the incision. Avoid sexual intercourse until the incision is healed or until you can go up and down two flights of stairs without difficulty breathing or becoming too tired.

·        Wound Care. When your doctor clears you to bathe, shower daily with soap. Dry the surgical wound well and keep it clean. Don’t apply any creams, lotions, or powders to the incision until it is fully healed and appears like normal skin. Please contact your doctor if the wound is inflamed or swollen, if the pain is worsening, or if the wound is leaking fluid or blood.

·        Diet. Your diet should be restricted in accordance to existing medical conditions. Eat healthily to promote wound healing.

·        Medication. If you are prescribed antibiotics, please take them until you finish them. Please take all medication as prescribed by your doctor.

·        Exercise. Practice breathing continuously. Walk at least once or twice a day. Avoid strenuous exercise for at least 2-4 weeks. Please follow the doctor’s recommendations.

·        Appointments. Please keep all follow-up appointments so your wound can be monitored and stitches removed. If you experience any abnormal symptoms, such as fever, difficulty breathing, worsening fatigue, worsening cough, coughing up abnormal sputum, etc., please see your doctor before the scheduled appointment.

  • You should plan to stay in Thailand for at least 2-3 weeks through the duration of your treatment.
  • It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure or from the day of the procedure to the day of your follow-up appointment.
  • When traveling by air, if you are seated in Economy Class, please choose an exit row or bulkhead seat for convenience in getting up and moving around every 15-30 minutes. Flex your ankles regularly to prevent deep vein thrombosis.
  • Please take all medication prescribed by your doctor. Carry the appropriate dosage of mediation in your carry-on luggage when you travel as well as a few extra doses in case of an emergency. Carry the prescription for all your medication to avoid problems at the airport.
The success of the procedure depends on a number of factors. Please discuss the likelihood of success with your doctor before the procedure.
 
What if this procedure is not performed?
This procedure can help relieve or even eliminate some of your symptoms. For lung cancer that can be operated on, it is very important to take it out as soon as possible. This can help keep it from spreading more within the lung and to other parts of the body. In general, people who do not have malignant lung cancer taken out die much sooner than people who do.

When you leave the hospital, your health care team will provide you with specific instructions about how to care for your healing skin and lungs. These instructions should cover driving, activity level, medications, and other matters to help in your recovery.
 
Alternatives
Chemotherapy and radiation.

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