Lobectomy

Lobectomy is a surgical procedure that removes one lobe of the lung. It is most commonly performed to treat localized early-stage non-small cell lung cancer but may also be used for benign conditions such as localized tumors, recurrent infections, or bronchiectasis that do not respond to medical therapy.

The operation is typically performed under general anesthesia with single-lung ventilation. Access can be through an open thoracotomy or a minimally invasive approach such as video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracic surgery (RATS). The bronchus to the affected lobe, along with its accompanying pulmonary arteries and veins, is divided and the lobe is removed. Mediastinal and hilar lymph nodes are usually sampled or dissected to help stage cancer and guide postoperative treatment. A chest tube is placed to drain air and fluid during the initial recovery.

Variations and related concepts include sleeve lobectomy, where part of the main bronchus is removed and the airway is reconnected to preserve more lung tissue, and more extensive procedures such as bilobectomy or pneumonectomy when disease involves multiple lobes or is not amenable to preservation. Lymph node assessment is commonly performed to stage cancer and detect potential spread.

Indications and considerations: candidates typically have adequate pulmonary reserve and resectable disease. Contraindications include poor lung function, extensive bilateral disease, or high operative risk. Postoperative care focuses on pain control, chest physiotherapy, and monitoring for complications.

Outcomes and risks: lobectomy offers substantial local control for suitable lung cancers and can provide a chance for cure in early stages. Potential complications include air leaks, infections, bleeding, atrial fibrillation, pneumonia, and, rarely, bronchopleural fistula. Recovery generally spans weeks to months, with gradual return to activity.