Lung resection, also called pulmonary resection, is a common surgical procedure involving the removal of a portion or, in some cases, an entire lung. This surgery is utilized when disease or damage has localized to a section of the lung, making removal necessary to preserve the patient’s overall health. The goal is to eliminate the source of the problem while minimizing the impact on the patient’s breathing function. Advances in surgical techniques and post-operative care have made this an established treatment for several serious conditions.
Defining Lung Resection and Its Primary Purpose
The goal of a lung resection is to surgically remove diseased or damaged tissue from the lungs while leaving as much healthy structure intact as possible. The human lungs are divided into lobes—three on the right and two on the left—which are further divided into smaller segments. Surgeons target the affected area with anatomical precision to maximize the preservation of functioning lung capacity.
The most common reason for this surgery is the treatment of malignancy, primarily lung cancer, where the resection removes the tumor and a surrounding margin of tissue. Resection may also be necessary for severe non-cancerous conditions. These include chronic infections like tuberculosis or fungal diseases, extensive lung abscesses, or localized emphysema not responding to other treatments.
The decision to proceed is made after evaluating the problem’s size, location, and the patient’s existing lung function. Preoperative testing, such as spirometry and diffusion capacity (DLCO), helps predict the patient’s postoperative lung function. This ensures they can tolerate the removal of lung tissue. If predicted post-operative values for functions like forced expiratory volume in one second (FEV1) are too low, the surgical plan may be adjusted to remove less tissue.
Different Types of Lung Resection Surgery
The extent of the tissue removed determines the specific type of lung resection performed, ranging from a small section to the entire organ.
Wedge Resection
This is the least extensive procedure, removing a small, non-anatomical, wedge-shaped piece of tissue. It is often used for diagnosis or for removing small, peripheral tumors. Because it removes the least amount of healthy lung tissue, it is favored for patients with limited pulmonary reserve.
Segmentectomy
Also called segmental resection, this precise procedure removes one or more anatomically defined segments of a lung lobe. This approach requires meticulous technique to preserve the surrounding tissue, blood vessels, and airways of the remaining segments. Segmentectomy is increasingly used for small, early-stage lung cancers, especially in patients who cannot tolerate a larger resection.
Lobectomy
This is the most common type of lung resection for localized lung cancer, involving the removal of an entire lobe. It is the standard treatment for many early-stage lung cancers because it provides a wide margin of tissue and removes associated lymph nodes. Removing an entire lobe is necessary when the disease has spread to the central structures supplying that lobe.
Pneumonectomy
This is the removal of an entire lung. This surgery is reserved for cases where the disease is extensive, involving the main bronchus or central blood vessels, making a smaller procedure impossible. Candidates undergo rigorous pre-operative testing to confirm that the remaining lung can sustain life, as this significantly impacts breathing capacity.
Surgical Approaches to Lung Resection
Surgeons use different methods to access the lung, and the chosen approach influences the patient’s recovery experience.
Open Thoracotomy
This traditional method requires a long incision, typically made on the side of the chest, and the use of specialized instruments to spread the ribs. This approach allows the surgeon a direct view and more space to operate. It is necessary for large, complex tumors or when extensive bleeding is anticipated.
Minimally Invasive Techniques
Modern surgical techniques utilize minimally invasive procedures, involving smaller incisions and less trauma to the chest wall.
Video-Assisted Thoracic Surgery (VATS) involves inserting a small camera and long, thin instruments through several small incisions. The camera transmits images to a monitor, allowing the surgeon to visualize the chest cavity and perform the resection without spreading the ribs.
Robotic-Assisted Thoracic Surgery (RATS) is an evolution of VATS where the surgeon controls robotic arms from a console. The robotic system offers enhanced three-dimensional visualization, greater dexterity, and a wider range of motion. Both VATS and RATS generally lead to less post-operative pain, fewer complications, and a shorter hospital stay compared to a traditional thoracotomy.
Recovery and Life After Surgery
The immediate post-operative period involves close monitoring, often including a hospital stay of two to five days, depending on the resection type and surgical approach. Patients typically wake up with one or more chest tubes in place. These tubes drain fluid and air from the chest cavity, allowing the remaining lung to fully expand, and are removed once drainage decreases and air leaks stop.
Pain management is a primary focus during initial recovery, as chest incisions can cause considerable discomfort. Patients receive nerve blocks or continuous pain medication to allow them to breathe deeply and cough effectively, which prevents post-operative pneumonia. Early mobilization, such as walking shortly after surgery, is encouraged to promote circulation and lung function.
Long-term recovery involves a gradual return to normal activity; fatigue is common for several weeks or months. Many patients are referred to pulmonary rehabilitation programs involving guided exercises and education to improve strength and breathing efficiency. The remaining lung tissue compensates for the removed portion, though a period of adjustment for breathing and physical activity levels is expected. Follow-up care monitors breathing function and screens for disease recurrence.