A sublobar resection is a surgical procedure that removes only a portion of a lung lobe, rather than the entire lobe. This lung-sparing technique aims to preserve as much healthy lung tissue as possible. Surgeons perform this procedure to address specific issues within the lung while minimizing the impact on overall lung function. It represents a precise method for localized removal of lung tissue.
Indications for Sublobar Resection
Sublobar resection is often considered for individuals with small, early-stage non-small cell lung cancer (NSCLC). It is suitable for peripheral nodules 2 centimeters or less, especially those with a ground-glass appearance or a long doubling time, indicating slower growth. A patient’s lung function and health are evaluated, as this option benefits those with limited pulmonary reserve or significant comorbidities.
Beyond NSCLC, sublobar resection is used for diagnosing suspicious lung nodules. It can also remove benign tumors or treat metastatic lung cancer. Patient selection confirms the cancer has not spread to lymph nodes, typically through preoperative imaging and sometimes intraoperative assessment.
Types of Sublobar Resection
Sublobar resection includes two primary techniques: wedge resection and segmentectomy.
A wedge resection removes a small, pie-shaped piece of lung tissue containing the abnormality and a margin of healthy tissue. This non-anatomical removal does not follow the lung’s segmental boundaries and typically does not require dissecting specific pulmonary vessels or bronchi. It is often performed for smaller, superficial lesions or when lung function is severely compromised.
A segmentectomy is a more complex anatomical resection that removes an entire lung segment. Lungs are divided into lobes—three on the right and two on the left—which are further subdivided into segments, each with its own bronchus and blood supply. During a segmentectomy, the surgeon dissects and seals these specific segmental structures. This allows for a wider margin of healthy tissue around the lesion compared to a wedge resection.
The Surgical Procedure
Sublobar resections use different surgical approaches, chosen based on tumor location, size, and surgeon expertise. Video-Assisted Thoracoscopic Surgery (VATS) and Robotic-Assisted Thoracic Surgery (RATS) are minimally invasive techniques that have become the standard for many lung resections.
These approaches involve several small incisions, typically 1 to 4 centimeters in length, on the chest. A camera is inserted through one incision to provide a magnified view, guiding the surgeon. Specialized instruments are threaded through other incisions to remove tissue, divide blood vessels, and seal airways. Both VATS and RATS avoid spreading the ribs, leading to less postoperative pain and faster recovery than open surgery.
An open thoracotomy involves a single, larger incision, often 8 to 15 centimeters, made between the ribs for direct access to the lung. While less common for sublobar resections, thoracotomy may be necessary for complex cases, larger tumors, or extensive adhesions. Lymph node samples are removed during the procedure for analysis.
Recovery and Postoperative Care
Following sublobar resection, patients remain in the hospital for a few days, with length of stay influenced by the surgical approach and individual recovery progress. A chest tube is placed to drain fluid or air and help the lung re-expand. This tube is removed once drainage is minimal and there are no significant air leaks, often within a few days.
Pain management is a significant aspect of immediate postoperative care, with various medications administered to keep discomfort at manageable levels. Patients are encouraged to perform deep breathing exercises using an incentive spirometer and to mobilize early by walking. Early movement helps prevent complications like pneumonia and blood clots, promoting better lung function and circulation.
Recovery at home continues for several weeks. Patients should gradually increase activity, avoiding strenuous activities like heavy lifting (over 10 pounds) or vigorous exercise for at least three weeks. Incision sites, which may have sutures or surgical glue, should be kept clean and dry, with showering typically permitted after 24 to 48 hours once the chest tube is removed. Most individuals return to light work and daily routines within two to four weeks, though full recovery may take longer depending on overall health and surgery extent.
Comparison with Lobectomy
Sublobar resection differs from a lobectomy, which removes an entire lung lobe. A primary advantage of sublobar resection is preserving more healthy lung tissue. This benefits patients with pre-existing lung conditions like emphysema or chronic bronchitis, where maintaining as much lung function as possible is important for their long-term breathing capacity.
Historically, sublobar resection had a higher risk of local cancer recurrence than lobectomy. However, recent clinical trials show that for small, peripheral non-small cell lung cancers (typically 2 cm or less and without lymph node involvement), sublobar resection can offer comparable long-term survival rates and disease-free survival to lobectomy. Some studies still indicate a slightly elevated recurrence risk, especially if surgical margins are inadequate or specific tumor characteristics are present. The decision between these procedures considers tumor characteristics, lung function, and overall health.