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.
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