Center for Thoracic Oncology

Treatments

Lung Resection

The Center for Thoracic Oncology at Boston Medical Center is, first and foremost, here to serve you and your family. We are a team of dedicated specialists whose common goal is to treat your cancer and lead you on the path to recovery in as comfortable a way as possible. You will be treated in state-of-the-art facilities using a multidisciplinary approach. Our staff of compassionate diagnosticians, surgeons, physician assistants, nurse practitioners, and surgical nurses work together to provide you with the most advanced and effective medical treatment in New England—as well as unmatched patient care.

Overview 

Lung resection is the surgical removal of all or part of the lung, because of lung cancer or other lung disease. Surgery can provide a cure in some cancer cases, when the tumor is discovered early. Your physician will recommend one of the following types of resection, depending on your diagnosis.

If you have cancer, the type of resection will be based on the tumor location, size, and type, as well as your overall health and lung function prior to diagnosis. On the right side, the lung has three anatomical parts (called lobes) and on the left there are two parts (lobes). Usually, an operation for cancer involves removing a lobe, which is called a lobectomy.

The type of lung resection used will depend on the location and size of your tumor, and also the ability of your remaining lung tissue to compensate for your breathing after surgery.  

• Wedge resection, or segmentectomy. These terms refer to the removal of an area of lung smaller than a lobe, usually the tumor and a small area of healthy lung tissue around it. This is a treatment used for early-stage cancer and sometimes to remove a piece of lung where cancer is suspected but not proven.
• Lobectomy. In a lobectomy, the surgeon removes a lobe of the lungs. This is the usual operation performed for lung cancer, as this has the best chance of removing all the cancerous tissue and decreasing the chance of cancer coming back.
• Pneumonectomy is the removal of an entire lung. This option is considered if a tumor is especially large, or in a difficult-to-reach or central position in the lung. Although pneumonectomy can result in significant loss of function, many people live quite well with only one lung.
• Video-assisted (VATS) lobectomy. The BMC thoracic surgery team was the first group of surgeons in New England with the expertise and technology to perform lung resections using VATS. This minimally invasive alternative to open chest surgery greatly reduces patient’s pain, recovery time and risk for infection.

When using VATS, the physician makes tiny incisions in the patient’s chest and inserts a thorascope (a fiber-optic camera) as well as surgical instruments. Your surgeon uses the images from the computer monitor as a guide during surgery. The surgeon has no need to stress or cut ribs, because all movements are performed at the tip of the instrument, at the point of contact with the cancerous tissue.  It may be possible to perform any of the resections (wedge, lobectomy, pneumonectomy) described above.

Further enhancing the precision of this process, BMC’s VATS technology is also unique in its use of multiple robot-powered cameras that provide three-dimensional views inside the chest.

How to Prepare

Lung resection is typically performed under general anesthesia, meaning you will be given medication to fall asleep during the procedure. It is important to follow any instructions given to you by your physician, to prepare for surgery. These instructions generally include:

• Avoiding eating or drinking anything after midnight on the night before
• Bringing all of your medications with you to the hospital
• Arriving one hour prior to your surgery time.

You may have a pre-admission appointment one to two weeks beforehand, in which you will have routine blood testing and consultation with the anesthesiologist, who is the specialist that administers medicine to put you to sleep and to ease any pain.  
   
If possible, engage in some mild physical activity such as walking, and eat a balanced diet leading up to your scheduled surgery. Please inform us of the following in the week before:

• If you drink alcohol on a regular basis, try to limit consumption to one to two glasses per day.
• All the medications that you take, both prescription and over-the-counter, including herbs, supplements, aspirin, and corticosteroids
• If you have asthma or emphysema

Smoking cessation must occur two to three weeks prior to surgery to be effective. Some operations will not be performed if you are still smoking.  

What to Expect

On the day before your procedure, you should receive a call from us. You will be given information about the following day, including where to go and when to arrive. When you arrive, you will be taken to a pre-surgery area so that we can take your temperature, blood pressure, pulse, and listen to your heart and lungs. Then, depending on your particular diagnosis and surgical plan, you may have your blood tested, have an x-ray, or be attached to a heart monitor in the surgery room. We will place an intravenous (IV) line in your arm, so that medications may be administered before, during, and after the procedure.  
   
Your surgery may take several hours. Your family may wait in the Family Waiting Room.

Recovery

After surgery, you will be taken to the Post Anesthesia Unit and monitored for any changes in blood pressure, heart rate, and breathing. An IV line will remain in your arm to keep you hydrated and to administer pain medication, if necessary. You may also require the use of a ventilator to ensure air exchange and to prevent pneumonia for a period after surgery.  
   
You may require the use of oxygen when you go home, but in most cases when this is required, it is only for a few weeks. Before you go home, your nurse will teach you how to use any equipment you might need, how to care for your incision, and review your medications with you. Gradually, over the course of a few weeks, you will regain your strength and be able to return to work and participate in physical activity. Be sure to call your doctor if you notice any of the following:  

• Bleeding
• Infection
• High temperature
• Coughing up yellow, green, or bloody mucus
• Allergic reaction, such as redness, swelling, trouble breathing
• Pain

Always take your medicine exactly as prescribed. Call us if you have any questions or changes.

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