Lung Lobe Resection

Lung cancer is one of the most common types of thoracic oncology worldwide. In Israel, around 1,500 new cases are diagnosed annually, mainly in smokers over the age of 40. In about 90% of cases, smoking is the primary cause.

Primary lung cancer originates in the lung tissue, while secondary lung cancer refers to metastases from other parts of the body that reach the lungs.

In roughly 30% of cases, lung cancer is detected at an early stage, making lung lobe resection a viable treatment option (typically stages I and II, though sometimes possible in stage III). At later stages, where metastases are present, treatments such as chemotherapy or radiation therapy are usually preferred.

About 85% of lung cancer cases are non-small cell lung cancer (NSCLC), which is typically operable. Small cell lung cancer (SCLC), in contrast, is rarely suitable for surgery.

The lungs are composed of five lobes: three in the right lung and two in the left. The type and scope of lung resection depend on the tumor’s size, location, and type.

There are three main types of surgery:

• Wedge resection in Israel – removal of a small section of the lung, typically for patients with low pulmonary function

• Lobectomy in Israel – removal of a full lobe

• Pneumonectomy in Israel – removal of an entire lung

Each year, about 700 lung resections are performed in Israel, primarily due to cancer, but sometimes due to other conditions such as trauma or severe infections.

When surgery is done at an early cancer stage, it often leads to a complete cure.

At Sourasky Medical Center, minimally invasive thoracoscopic surgery is used for lung lobe resection. The procedure is done through three small incisions, preserving the ribs and surrounding structures.

The operation is conducted under general anesthesia. The patient is fitted with IV lines, a catheter, a stomach feeding tube, and an endotracheal tube for single-lung ventilation. A bronchoscope and video camera allow the surgical team to monitor the lung condition in real time on-screen.

Some patients also receive epidural anesthesia for postoperative pain control. The epidural catheter remains in place for several days, allowing the patient to self-administer analgesics.

Although open surgery is technically simpler, thoracoscopic methods result in less pain and quicker recovery. Therefore, we prioritize minimally invasive techniques and switch to open surgery only when necessary.

This approach is known as video-assisted thoracoscopic lobectomy, a minimally invasive operation that removes the affected lobe and nearby lymph nodes. Intraoperative rapid biopsy is often performed to ensure the tumor is fully excised and determine the cancer type.

General anesthesia.

2–3 hours.

Following surgery, patients spend 2 hours in recovery before being transferred to the thoracic surgery ward. Most patients resume independent breathing shortly after. Some may require brief ventilatory support.

Pain, fatigue, and difficulty breathing are common initially, but managed with medication. Deep breathing, coughing, and walking are crucial to recovery and prevent lung complications.

Daily X-rays are typically performed to monitor lung function and recovery progress.

Recovery typically takes 2–3 weeks, during which rest and physical therapy are recommended.

A follow-up appointment with the operating surgeon is scheduled about two weeks after discharge. Patients are then referred to an oncology department for further treatment, often chemotherapy.

If symptoms such as fever over 38°C, chest pain, or difficulty breathing occur, the patient should contact the hospital or return for urgent evaluation.