Lung Resection (Lobectomy, VATS)

Each lung is divided into lobes, three on the right and two on the left, and each lobe into smaller segments with their own airway and blood supply. Lung resection removes the part of the lung that contains the disease. A wedge resection takes out a small, non-anatomical piece of lung around a nodule and is often used for diagnosis or for small metastases. A segmentectomy removes one or more anatomical segments and can be an option for small early cancers or for people with limited lung function. A lobectomy removes a whole lobe and is a standard operation for lung cancer, because it removes the tumour together with its lymphatic drainage. A pneumonectomy removes an entire lung and is reserved for central tumours that cannot be removed in any other way. In cancer surgery, lymph nodes in the centre of the chest are also removed or sampled, so that the stage of the disease can be confirmed.

The most common reason is non-small cell lung cancer at an early stage, where surgery aims to remove the disease completely. Before recommending it, the team confirms the diagnosis and stage with a CT scan, a PET-CT scan and often sampling of chest lymph nodes by EBUS bronchoscopy, because cancer that has spread widely is treated with other approaches. Lung resection is also used to diagnose and remove a growing or suspicious nodule when a needle biopsy is not possible or not conclusive, to remove a limited number of metastases from cancers elsewhere in the body, and to treat carcinoid and other tumours. Less often it treats non-cancer conditions such as a localised area of bronchiectasis, a lung abscess, a fungal infection or a congenital malformation that has not settled with other treatment. A multidisciplinary tumour board usually reviews cancer cases, and treatment before or after surgery may be advised.

The operation is done under general anaesthesia with a special breathing tube that allows the lung being operated on to be deflated while the other lung keeps breathing. In VATS, the surgeon works through one to four small cuts between the ribs using a camera and long instruments; robotic surgery uses a similar approach with instruments controlled from a console. In an open thoracotomy, a longer cut is made along the side of the chest and the ribs are spread. The surgeon divides the artery, vein and airway of the part to be removed, staples the lung tissue, removes the specimen in a bag and samples or removes the lymph nodes. The lung is then reinflated and checked for air leaks. One or two chest drains are placed to remove air and fluid. Most operations take about 2 to 4 hours, and if keyhole surgery proves unsafe, the surgeon converts to an open approach.

Before surgery, the team checks that you can safely manage with less lung. Breathing tests measure how much air you can move and how well oxygen passes into the blood, and some people also do a stair-climbing or exercise test. A heart assessment, blood tests and an up-to-date staging scan complete the picture. Stopping smoking as early as possible lowers the risk of chest infection and other complications, and many programmes use a short prehabilitation period of walking, breathing exercises and good nutrition to build strength before the operation. Blood thinners and other medicines are adjusted on medical advice. Poor lung function or serious heart disease may favour a smaller resection or a non-surgical treatment such as targeted radiotherapy. International patients can send CT and PET-CT images, biopsy reports and breathing tests in advance, so the team can plan staging and surgery as one programme.

You wake in a recovery or high-dependency area and are encouraged to sit up, breathe deeply, cough and walk from the first day, supported by a physiotherapist and good pain relief. The chest drain is removed when air and fluid leakage has stopped, often after one to three days after keyhole surgery. The hospital stay is typically a few days after VATS or robotic surgery and up to a week or more after open surgery or a pneumonectomy. Tiredness and some breathlessness are common for several weeks, and numbness or aching around the cuts can last longer. Flying is usually possible about two to four weeks after surgery, once the drain is out, a chest X-ray shows no trapped air and your surgeon clears you. Plan to stay for the results of the tissue report, usually within one to two weeks, which decides whether any further treatment, such as chemotherapy or immunotherapy, is needed and where it can be given.

Lung resection is major surgery, and its risks are higher with larger resections, poorer lung function and other illnesses. The most common problem is a prolonged air leak from the stapled lung surface, which usually settles with a longer stay or going home with a small drain valve. Other risks include chest infection or pneumonia, an irregular heart rhythm called atrial fibrillation, bleeding, blood clots and wound infection. Some people have long-lasting pain or numbness along the chest wall, more often after open surgery. Removing lung tissue reduces breathing reserve; most people adapt well after a lobectomy or smaller resection, while a pneumonectomy has a greater and lasting effect on exercise capacity. For cancer, the result depends on the stage confirmed by the tissue report, and your team explains what it means for you and what follow-up scans are needed.