A posterolateral thoracotomy is the commonest approach for the resection of lung malignancies. For other surgical approaches for lobectomy see the main article on lung surgery.
A standard lobectomy involves complete resection of a whole lobe of the lung with concurrent removal of the associated pulmonary vasculature, bronchi, visceral pleura, and mediastinal nodal dissection.
A multilobar resection is a bilobectomy or lobectomy plus sublobar resection and may be necessary when more than one lobe is involved, usually due to pleural invasion or an incomplete lobar fissure 1.
A sleeve lobectomy, which is a lobectomy coupled with partial resection of a bronchus, is usually performed when there is malignant involvement of the main bronchus/lobar bronchial lumen. The remaining native bronchi are anastomosed 1.
Significant morbidity post lobectomy is common, in the elderly it approaches 50% of all cases 6.
Mortality remains a real risk after a lobectomy, it was 2.6% in a review of the National Cancer Database in the US in 2014 5.
- prolonged air leak (>7 days): commonest complication post-lobectomy, up to 18% 5
- atelectasis: common
- pneumonia (rarely empyema)
- atrial fibrillation: common
- postoperative pulmonary edema
- bronchial dehiscence
- hemothorax: hemorrhage is common, 2.9% require ≥4 units packed cells 5
- chylothorax: more common with aggressive mediastinal nodal dissections 5
- bronchopleural fistula (BPF): very rare after lobectomy 5
- lobar torsion: rare and potentially life-threatening, usually right middle lobe (70% cases) 5
- pulmonary vein stump thrombosis: rare after lobectomy
- anastomotic dehiscence: more common with sleeve lobectomy
- pulmonary embolism (PE)
- nerve injury: phrenic nerve, recurrent laryngeal nerve
History and etymology
The original development of lobectomy was for the treatment of tuberculosis, specifically a partial lobectomy in 1893 by the British surgeon David Lowson (1850-1907) 4.
- 1. de Groot PM, Truong MT, Godoy MCB. Postoperative Imaging and Complications in Resection of Lung Cancer. (2018) Seminars in ultrasound, CT, and MR. 39 (3): 289-296. doi:10.1053/j.sult.2018.02.008 - Pubmed
- 2. Rotman JA, Plodkowski AJ, Hayes SA, de Groot PM, Shepard JA, Munden RF, Ginsberg MS. Postoperative complications after thoracic surgery for lung cancer. (2015) Clinical imaging. 39 (5): 735-49. doi:10.1016/j.clinimag.2015.05.013 - Pubmed
- 3. Kang YR, Kim JS, Cha YK, Jeong YJ. Imaging findings of complications after thoracic surgery. (2019) Japanese journal of radiology. 37 (3): 209-219. doi:10.1007/s11604-018-00806-y - Pubmed
- 4. Anton Sebastian. A Dictionary of the History of Medicine. (1999) ISBN: 9781850700210
- 5. Ziarnik E, Grogan EL. Postlobectomy Early Complications. (2015) Thoracic surgery clinics. 25 (3): 355-64. doi:10.1016/j.thorsurg.2015.04.003 - Pubmed
- 6. Berry MF, Hanna J, Tong BC, Burfeind WR, Harpole DH, D'Amico TA, Onaitis MW. Risk factors for morbidity after lobectomy for lung cancer in elderly patients. (2009) The Annals of thoracic surgery. 88 (4): 1093-9. doi:10.1016/j.athoracsur.2009.06.012 - Pubmed