A lobectomy (plural: lobectomies) is the complete resection of one lobe of the lung and is the most common lung surgery performed for lung cancer.

Technique

A posterolateral thoracotomy is the most common 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.

Postoperative complications

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 oedema

• ARDS

• bronchial dehiscence

• haemothorax: haemorrhage 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.