Lung surgery

Last revised by Daniel J Bell on 21 Jan 2020

Lung (or pulmonary) surgery is most frequently performed for lung carcinoma, and encompasses a broad spectrum of procedures:

  • posterolateral thoracotomy
    • commonest approach for resection of lung malignancies
  • anterolateral, lateral and axillary thoracotomies are less common
  • muscle-sparing techniques are becoming more popular
    • displacement of chest wall muscles instead of dividing the muscles
    • preserve muscle functionality after surgery
  • median sternotomy
    • preferred approach for simultaneous access to both hemithoraces if lesions to be resected are in both lungs
  • minimally-invasive surgery
  • wedge resection (non-anatomic) and segmentectomy (anatomic)
  • ideal for low stage lung carcinoma e.g. stage IA non-small cell lung cancer 1
  • other indications:
    • multifocal synchronous adenocarcinoma in situ
    • metastases
    • metachronous lesions
  • suboptimal for later-stage cancers
  • see also main article: lobectomy
  • complete resection of a whole lobe of the lung and also necessitates removal of the associated pulmonary vasculature, bronchi, visceral pleura and mediastinal nodal dissection
  • bilobectomy or lobectomy plus sublobar resection may be necessary when more than one lobe is involved, usually due to pleural invasion or incomplete fissure

  • in addition to the lobectomy partial resection of a bronchus is also required
  • usually due to malignant involvement of the main bronchus/lobar bronchial lumen: remaining native bronchi are anastomosed
  • see also main article: pneumonectomy
  • the whole lung is removed
    • intrapleural or extrapleural: only visceral, or visceral and parietal pleura removed
    • intrapericardial or extrapericardial
  • indication: bulky/central tumors or ipsilateral recurrence
  • morbidity and mortality are higher than for other forms of lung surgery

The original development of lobectomy was for the treatment of tuberculosis, specifically a partial lobectomy in 1893 by a British surgeon David Lowson (1850-1907). It was the American surgeon, Evarts Ambrose Graham (1883-1957) who introduced pneumonectomy as a curative treatment for bronchogenic carcinoma in 1932 2,3.

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