Lobectomie

Lobectomie, or lobectomy, is the surgical removal of one lobe of the lung. It is commonly performed to treat localized disease, most often primary lung cancer, but can also be indicated for certain benign conditions or recurrent localized infections.

Indications include primarily early-stage non-small cell lung cancer confined to a single lobe and deemed resectable with adequate pulmonary reserve. It may also be used in selected cases of localized metastasis or extensive benign conditions such as recurrent infections, bronchiectasis, or sequestration where the diseased lobe is responsible for symptoms or complications. The procedure aims to remove the diseased tissue while preserving as much healthy lung as possible.

Preoperative assessment involves evaluation of cardiopulmonary function, typically with spirometry and diffusing capacity (DLCO), imaging with CT chest, and sometimes PET-CT. Lymph node assessment may be planned for cancer cases, with sampling or dissection performed during surgery. The choice of surgical approach depends on tumor location, anatomy, and surgeon expertise, with options including open thoracotomy, video-assisted thoracic surgery (VATS), or robotic-assisted thoracic surgery (RATS).

During the operation, the targeted lobe is removed along with its bronchus and pulmonary vessels, usually with regional lymph nodes sampled or dissected. The remaining lung is re-expanded, and a chest drain is placed to remove air and fluid during the immediate postoperative period.

Postoperative care emphasizes pain control, pulmonary rehabilitation, early mobilization, and chest physiotherapy. Hospital stay typically ranges from several days to a week, depending on recovery and complications. Common complications include prolonged air leak, infection, atelectasis, pneumonia, atrial fibrillation, bleeding, and chylothorax, though rates vary by patient and comorbidity.

Outcomes depend largely on tumor stage and overall health. Lobectomy offers favorable oncologic outcomes for appropriately selected patients with stage I non-small cell lung cancer compared with sublobar resections, while higher stages or poor pulmonary reserve may limit benefit.