Background Information:

What are the other Names for the Procedure?

• Pneumonectomy
• Total Pneumonectomy
• Wedge Resection of Lung

What is Lung Resection surgical procedure?

• Lung Resection is a surgical procedure that involves the removal of tissue from within the lungs.
• This procedure is called a Lobectomy, if only a portion of the lung is removed
• This procedure is called a Total Pneumonectomy, if the entire lung is removed
• If a portion of the lobe is removed, then it is called a Wedge Resection of Lung

What part of the Body does the Procedure involve?

A Lung Resection procedure involves the lung, bronchial tubes, and the surrounding blood vessels within the chest and ribs.

Why is the Lung Resection surgical procedure Performed?

The Lung Resection procedure is performed for the following reasons:

• Removal of suspected cancerous tumor, within a lung
• If the lung is severely damaged, following an injury to the chest
• Rarely, for chronic obstructive pulmonary disease and pus collections (lung abscess), which do not respond to antibiotic therapy

What are some Alternative Choices for the Procedure?

Other treatment options for lung cancers include radiation therapy or chemotherapy. The treatment modality chosen depends on multiple factors.

What are the Recent Advances in the Procedure?

No significant recent advances are noted for Lung Resection surgical procedure. 

What is the Cost of performing the Lung Resection surgical procedure?

The cost of a Lung Resection surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Lung Resection procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.surgery.com/procedure/pneumonectomy (accessed on 08/25/2014)

http://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/lobectomy_92,P07749/ (accessed on 08/25/2014)

Prior to Lung Resection surgical procedure:

How is the Lung Resection surgical procedure Performed?

• A Lung Resection is performed under general anesthesia
• For Pneumonectomy procedure:
  • The surgeon makes an incision under the shoulder blade, on the diseased side and extends it along the side of the chest onto the front, following the curvature of the ribs to enter into the chest cavity
  • A portion of the fifth rib may be removed to make Lung Resections easier
  • After collapsing the lung, the surgeon clamps the blood vessels feeding it. The surgeon also clamps and cuts the primary bronchus (a large tube arising from the windpipe that carries air in and out of lungs)  
  • The lung is then removed
• For Lobectomy procedure:
  • The surgeon makes an incision on front of the chest at the level of the lobe (a portion of lung) that is being removed
  • The overlying ribs are spread apart
  • The blood supply and air tubes supplying the lobe are tied and cut     
  • The lobe is then removed
• After surgery, chest tubes are placed to remove any air or fluid that may collect post-operatively
• The skin incision is closed

Where is the Procedure Performed?

A Lung Resection procedure is performed at a hospital.

Who Performs the Procedure?

A thoracic surgeon performs a Lung Resection procedure.

How long will the Procedure take?

The Lung Resection procedure may take anywhere between 1-3 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Lung Resection surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Normally local anesthesia is not used; however, do inform the physician if you are allergic to any local anesthetics, lidocaine, etc
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Lung Resection surgical procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Lung Resection surgical procedure?

Prior to a Lung Resection procedure, the patient has to undergo certain tests, such as:

• Routine blood and urine analysis
• Chest x-ray
• Electrocardiography (ECG)
• Computerized tomography (CT) scan of lung
• Bronchoscopy
• Pulmonary function test (PFT)

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Lung Resection procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Lung Resection surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia by injection and inhalation is administered prior to the Lung Resection procedure.

How much Blood will you lose, during the Procedure?

• Generally, the blood loss during a Lung Resection procedure is minimal
• Sometimes, a major blood vessel may be damaged during the procedure, resulting in an increased blood loss. In such case, blood transfusion may be necessary, during the surgery

What are the possible Risks and Complications during the Lung Resection surgical procedure?

There are general factors that increase the risk of getting complications during the surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Lung Resection surgery are:

• Excessive bleeding
• Infection surrounding the surgical would
• Air leakage collapsing the lung (tension pneumothorax)
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Lung Resection surgical procedure?

• After the Lung Resection surgical procedure, patients will be sent to an area of the hospital called postoperative recovery area (PACU)
• A patient’s blood pressure, heart rate, and respiration cycle, will be closely monitored. Any additional pain associated with the procedure will also be treated
• A short stay in the surgical ICU may also be warranted, before transfer to regular inpatient ward.  Medications to control pain and exercises to promote clearing of lung secretions are given
• Individuals are usually discharged from the hospital 7-10 days after the surgery is performed

After the Lung Resection surgical procedure:

What are the possible Risks and Complications after the Lung Resection surgical procedure?

The possible risks and complications that may arise after Lung Resection procedure are:

• Excessive bleeding
• Infection in the surgical wound
• Pus collection in the chest wall space
• Pneumonia
• Decreased respiratory function
• Bronchopleural fistula (BPF) - a passage forms between the air tubes and the pleural space, which is a gap between the chest wall and lung
• Leakage of air into the lung cavity/thorax from the lung (prolonged air leakage)

What is the Prognosis after the Surgery?

The prognosis is usually good after the procedure. However, following a Total Lung Resection, long-standing shortness of breath may be expected.

When do you need to call your Physician?

Do contact your physician, if you notice any of the following symptoms:

• Worsening pain and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, or breathing difficulty
• Signs of an infection
• Fever, feeling sick
• Dizziness
• Muscle aches, headaches
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Lung Resection surgical procedure?

At home, the following post-operative care is recommended, after a Lung Resection procedure:

• Slowly resume regular/daily activities as soon as possible, which aids in faster recovery
• Use a heat pad or warm compress, in order to relieve pain due to the incision
• Resume showering and keep the wound clean and dry. Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with unscented soap and re-bandage it again
• Take deep breaths and cough regularly, to help prevent secretion buildup within the lungs
• Elevate legs while resting, to prevent the formation of blood clots and reduce the possibility of swelling
• Complete the course of prescribed medication, or follow your physician’s advice
• Take antibiotic medication to help combat or prevent infection (per physician’s advice)
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain
• Get vaccinated to help prevent pneumonia
• Avoid all activities that are physically strenuous for about 6 weeks after the surgery
• Resume driving 5 weeks after being discharged from the healthcare facility (or as advised by your physician)
• Individuals are advised to have to clear liquids immediately after the surgery, until the gastrointestinal tract begins properly functioning. Individuals are then advised to have a well-balanced diet, which can aid in a faster recovery

How long does it normally take to fully recover, from the Procedure?

Recovery, following an uneventful operative and immediate post-operative period, usually occurs in about 4-6 weeks’ time.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The lung tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Lung Resection surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A hospital
• An anesthesiologist (if anesthesia was administered)
• A pathologist
• A thoracic surgeon

The patient is advised to inquire and confirm the type of billing, before the Lung Resection surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA