What Is a Lobectomy?

Lobectomy is a procedure that is used to take out part of the lung (called a lobe), because it has a
cancerous tumor in it. It is used to relieve some or all of the lung cancer symptoms that a person
is feeling. A lobectomy can keep a person's health from getting worse and it may provide the best
chance for curing the disease.

Demographics
Lung cancer
Lung cancer is the leading cause of cancer-related deaths in the United States. It is expected to claim
nearly 157,200 lives in 2003. Lung cancer kills more people than cancers of the breast, prostate, colon,
and pancreas combined. Cigarette smoking accounts for nearly 90% of cases of lung cancer in the United
States. Lung cancer is the second most common cancer among both men and women and is the
leading cause of death from cancer in both sexes. In addition to the use of tobacco as a major
cause of lung cancer among smokers, second-hand smoke contributes to the development of lung
cancer among nonsmokers. Exposure to asbestos and other hazardous substances is also known
to cause lung cancer. Air pollution is also a probable cause, but makes a relatively small
contribution to incidence and mortality rates. Indoor exposure to radon may also make a small
contribution to the total incidence of lung cancer in certain geographic areas of the United States.

The lungs are comprised of lobes. The right lung has a superior lobe, middle lobe and inferior lobe. The
left lung has a superior and inferior lobe
Purpose
Lobectomies are performed to prevent the spread of cancer to other parts of the lung or other
parts of the body, as well as to treat patients with such noncancerous diseases as chronic
obstructive pulmonary disease (COPD). COPD includes emphysema and chronic bronchitis,
which cause airway obstruction.

Description Lobectomies of the lung are also called pulmonary lobectomies. The lungs are a pair of cone-
shaped breathing organs within the chest. The function of the lungs is to draw oxygen into the body and
release carbon dioxide, which is a waste product of the body's cells. The right lung has three lobes: a
superior lobe, a middle lobe, and an inferior lobe. The left lung has only two, a superior and an inferior
lobe. Some lobes exchange more oxygen than others. The lungs are covered by a thin membrane called
the pleura. The bronchi are two tubes which lead from the trachea (windpipe) to the right and left lungs.
Inside the lungs are tiny air sacs called alveoli and small tubes called bronchioles. Lung cancer sometimes
involves the bronchi.

To perform a lobectomy, the surgeon makes an incision (thoracotomy) between the ribs to
expose the lung while the patient is under general anesthesia. The chest cavity is examined and
the diseased lung tissue is removed. A drainage tube (chest tube) is then inserted to drain air,
fluid, and blood out of the chest cavity. The ribs and chest incision are then closed.

Lung surgery may be recommended for the following reasons:

 presence of tumors
 small areas of long-term infection (such as highly localized pulmonary tuberculosis or
mycobacterial infection)
 lung cancer
 abscesses
 permanently enlarged (dilated) airways (bronchiectasis)
 permanently dilated section of lung (lobar emphysema)
 injuries associated with lung collapse (atelectasis, pneumothorax, or hemothorax)
 a permanently collapsed lung (atelectasis)

Diagnosis
The symptoms of lung cancer vary somewhat according to the location of the tumor; they may
include persistent coughing, coughing up blood, wheezing, fever, and weight loss. Patients with a
lung abscess often have symptoms resembling those of pneumonia, including a high fever, loss
of appetite, general weakness, and putrid sputum. The doctor will first take a careful history and
listen to the patient's breathing with a stethoscope. Imaging studies include x ray studies of the
chest and CT scans. If lung cancer is suspected, the doctor will obtain a tissue sample for a
biopsy.

A test may be used before surgery to help determine how much of the lung can safely be
removed. This test is called a quantitative ventilation/perfusion scan, or a quantitative V/Q scan.
Preparation
Patients should not take aspirin or ibuprofen for seven to 10 days before surgery. Patients should
also consult their physician about discontinuing any blood-thinning medications such as
Coumadin (warfarin). The night before surgery, patients should not eat or drink anything after
midnight.

If a cancer or lesion is within a lobe of the lung, removal of the involved lobe is indicated. Under
general anesthesia with the patient deep asleep and pain free, an incision is made between the ribs
to expose the lung. The chest cavity is examined and diseased lung tissue is removed. A drainage
tube (chest tube) is inserted to drain air, fluid, and blood out of the chest cavity and the ribs and
skin are closed

Aftercare
The patient is transferred from the surgical intensive care unit (ICU) to a regular hospital room within one
to two days. Patients may need to be hospitalized for seven to 10 days after a lobectomy. A tube in the
chest to drain fluid will probably be required, as well as a mechanical ventilator to help the patient
breathe. The chest tube normally remains in place until the lung has fully re-expanded. Oxygen may also
be required, either on a temporary or permanent basis. A respiratory therapist will visit the patient to teach
him or her deep breathing exercises. It is important for the patient to perform these exercises in order to
re-expand the lung and lower the risk of pneumonia or other infections. The patient will be given
medications to control postoperative pain. The typical recovery period for a lobectomy is one to three
months following surgery.
Hospital stay is usually 7 to 10 days. Deep breathing is important to help prevent pneumonia, infection,
and re-expand the lung. The chest tube remains in place until the lung has fully re-expanded. Pain is
managed with medications. The patient recovers fully in 1 to 3 months after the operation.

Risks
The specific risks of a lobectomy vary depending on the specific reason for the procedure and the
general state of the patient's health. The risks for any surgery requiring a general anesthetic
include reactions to medications and breathing problems. As previously mentioned, patients
having part of a lung removed may have difficulty breathing and may require the use of oxygen.
Excessive bleeding, wound infections, and pneumonia are possible complications of a
lobectomy. The chest will hurt for some time after surgery, as the surgeon must cut through the
patient's ribs to expose the lung. Patients with COPD may experience shortness of breath after
surgery.

Normal results

This variability is related to the fact that lung tissue does not regenerate after it is removed.
Removal of a large portion of the lung may require a person to need oxygen or ventilator support
for the rest of his or her life. On the other hand, removal of only a small portion of the lung may
result in very little change to the patient's quality of life.
Morbidity and mortality rates
A small percentage of patients undergoing lung lobectomy die during or soon after the surgery.
This percentage varies from about 3–6% depending on the amount of lung tissue removed. Of
cancer patients with completely removable stage-1 non-small cell cancer of the lung (a disease in
which malignant cancer cells form in the tissues of the lung), 50% survive five years after the
procedure.

Alternatives
Lung cancer

The treatment options for lung cancer are surgery, radiation therapy, and chemotherapy, either
alone or in combination, depending on the stage of the cancer.

After the cancer is found and staged, the cancer care team discusses the treatment options with
the patient. In choosing a treatment plan, the most significant factors to consider are the type of
lung cancer (small cell or non-small cell) and the stage of the cancer. It is very important that the
doctor order all the tests needed to determine the stage of the cancer. Other factors to consider
include the patient's overall physical health; the likely side effects of the treatment; and the
probability of curing the disease, extending the patient's life, or relieving his or her symptoms.

Nursing intervention:
1. Monitor pulmonary status as directed and as needed:
a. Auscultate breath sounds
b. Checked rate, depth, and pattern of respirations.
c. Assess blood gasses for sign of hypoxemia or CO2 retention.
d. Evaluate patient color for cyanosis
2. Monitor and record blood pressure apical pulse, and temperature every 2-4 hours, central
venous pressure (if indicated) every 2 hours.
3. Monitor continuous electrocardiogram for pattern and dysrhythmias
4. Evaluate head of bead 30-40 degrees when patient is oriented and hemodynamic status is
stable.
5. Encourage deep-breathing exercise and effective use of incentive spirometer (sustained
maximal inspiration).
6. Encourage and promote an effective cough routine to be performed every 1-2 hours during
first 24 hours
7. Assess and monitor the chest drainage system
a. Assess for leaks and patency as needed
b. Monitor amount and character of drainage and document every 2 hours. Notify
physician if drainage is 150 mL/h or greater.
 Wesleyan University – Philippines

Mabini Extension Cabanatuan City

Submitted to:
Mr. Jonathan Ocampo R.N., MAN

Submitted by:
Maria Carmela V. Tormes
BSN 3-11