Lobectomy - Lung Lobe Removal Surgery

Removing one lobe of the lung is the operation that cures early lung cancer. Done through three small cuts, it sends most patients home in three to five days. The lung that remains does the work of the whole.

A lobectomy removes one of the five lobes of the lungs, three on the right and two on the left, together with the lymph nodes that drain it. It has been the standard operation for lung cancer since a randomized trial in 1995 showed that taking less than a lobe tripled the rate of recurrence at the site (Ginsberg and Rubinstein, Annals of Thoracic Surgery, 1995). A Japanese trial published in 2022 then showed that for tumors of two centimeters or less at the edge of the lung, removing a single segment gave five-year survival of 94.3 percent against 91.1 percent for lobectomy (Saji and colleagues, Lancet, 2022), so the operation is now matched to the tumor. Done by video-assisted thoracoscopic surgery, VATS, through small incisions, it causes less pain and a better quality of life for the first year than open surgery (Bendixen and colleagues, Lancet Oncology, 2016). This page explains what a lobectomy is and who needs one, how surgeons choose between keyhole, robotic and open approaches, what the operation and recovery involve, the risks, what the trials show, and how patients from abroad arrange it at Biruni Hospital in Istanbul.

What a lobectomy is

Each lung has lobes, and each lobe has its own airway, artery and vein. A lobectomy divides those three structures, separates the lobe from its neighbors along the fissures, and lifts it out with the tumor inside it and a margin of healthy lung around it. The lymph nodes along the airway and in the center of the chest are removed at the same time and examined, because they decide the stage and whether chemotherapy follows. The remaining lobes expand over the following weeks to fill the space.

Why a whole lobe

When less is enough

For a solid tumor of two centimeters or less at the edge of the lung, the Japanese trial of 1,106 patients showed that removing the segment that contains it gives survival at least as good, with 3.5 percent more breathing capacity preserved and a local relapse rate of 10.5 percent against 5.4 percent that did not translate into more deaths. A segmentectomy asks more of the surgeon than a lobectomy, because the planes between segments are not marked by fissures, and the choice between the two is made on the CT before surgery and confirmed at the operation.

Who needs one

Cancer, for nine patients in ten. A handful of benign diseases for the rest.

Keyhole, robotic or open

Same operation inside the chest. Different route in.

The three routes

1. Anesthesia. General anesthesia with a double-lumen tube that lets the anesthesiologist collapse the lung being operated on while the other breathes.
2. Exposure. The patient lies on the side. The incisions are made, the camera goes in, and the lobe is inspected to confirm the plan.
3. Division. The vein, the artery and the airway to the lobe are isolated one by one and divided with stapling devices that seal as they cut. The fissures are stapled.
4. Nodes. Lymph nodes from at least three stations in the center of the chest are removed for the pathologist.
5. Closure. A chest tube is placed, the lung is reinflated under direct vision to check for leaks, and the incisions are closed with absorbable sutures.

The operation and the days after

Two to three hours in the operating room. Three to five nights in the hospital. Four to six weeks to feel like yourself.

The first days

1. Week one at home. Walking daily, increasing distance. Painkillers by mouth. The wound check at the clinic.
2. Weeks two to four. Stairs, light housework, short outings. Breathlessness on effort that improves week by week. The pathology report and the decision on chemotherapy.
3. Weeks four to eight. Return to desk work, driving, and, after six weeks, lifting and sport. Air travel from two weeks, once the surgeon has confirmed on X-ray that no air remains in the chest.
4. Three months and beyond. Breathing capacity settles at 80 to 90 percent of what it was, and for most people that difference is not felt in daily life.

During 52 weeks of follow-up, episodes of moderate-to-severe pain were significantly less frequent after VATS than after anterolateral thoracotomy, and self-reported quality of life was significantly better (Bendixen and colleagues, 2016).

Risks and life with one lobe less

Lower than they were. Not zero.

No 30-day or 90-day mortality was observed in either group, and one or more postoperative complications of grade 2 or worse occurred in 26 percent after lobectomy and 27 percent after segmentectomy (Saji and colleagues, 2022).

Living with one lobe less

1. Breathing. The remaining lobes take over most of the function of the one removed. Patients who were not short of breath before are rarely short of breath afterward at rest or on ordinary exertion. Climbing, running and altitude are felt for a few months and then, for most, no longer.
2. Pain. A numb or tender patch below the incisions for months, and in a minority of patients a chronic pain along the rib that needs a nerve block or medicine.
3. Follow-up. A CT scan every six months for two years and yearly to five years, because a patient who has had one lung cancer is at risk of another, and the second is caught early on the same schedule.

What the trials show

Three randomized trials, thirty years apart, settled the three questions patients ask.

Because of the higher death rate and locoregional recurrence rate associated with limited resection, lobectomy still must be considered the surgical procedure of choice for patients with peripheral T1 N0 non-small cell lung cancer (Ginsberg and Rubinstein, 1995). The sentence stood for 27 years, and the tumors it still applies to are the ones larger than two centimeters.

Coming from abroad

One visit or two.

Lung surgery abroad is arranged either way. A patient with a biopsy-proven cancer, a PET scan and breathing tests from home can come once, for the tumor board, the operation and the recovery, and return home after the wound check. A patient whose diagnosis is not yet secure comes for the staging first, which the hospital completes in a week with PET, bronchoscopy with ultrasound of the nodes where needed, and breathing tests, and then either stays on for surgery or returns for it. The length of stay for surgery is 12 to 16 days, covering the pre-operative assessment, three to five nights in hospital, and a week of recovery near the hospital before the surgeon clears the patient to fly, which needs a chest X-ray without residual air, at 10 to 14 days for the majority. Companions may stay on the ward during the day, and a family member who will help at home is shown the breathing exercises and the wound care before discharge, since the first week at home goes better when someone else has heard the instructions too.

One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number once you are back home. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages. It arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital for the patient and a companion. The kitchen prepares halal, vegetarian and diabetic meals, a prayer room is on site, and a request for a female physician is met wherever the rota allows.

What to send

The CT of the chest as image files, the PET report and images, the biopsy report, the breathing tests, a recent ECG and, for patients over 65 or with heart disease, an echocardiogram, the list of medicines including blood thinners, and a note of smoking history. The thoracic surgery team replies within a few working days with a view on whether surgery is the right treatment, which operation and which approach are proposed, the length of stay and a cost estimate. Some patients turn out at review to be better served by radiation or by drug treatment first. The team says so plainly.

Cost

An estimate follows the file review and covers the operation, anesthesia, the hospital stay, pathology of the specimen and the nodes, the chest tube period and the wound check. Hospitals in this market quote lobectomy as a package with keyhole and robotic approaches priced differently, and with staging tests, chemotherapy and a longer stay for complications listed separately.

Confirm what the figure includes and what a longer stay for an air leak would add.