Doctor: surgery to remove a lobe of the lung.
Patient: Huh? You’re going to cut away a lobe of the lung? Wait, how many lobes do I have in total? Wait, how many lobes do I have? Will I be unable to breathe after this?
……
The above scenario is commonly encountered by doctors. You may have similar questions. When you are about to have surgery, you may be worried: Will one of the missing lobes affect your normal breathing? Here are some questions and answers that may help you solve the mystery.
How many lobes of the lung do we have?
How many lobes do we have?
There are 5 lobes of the lung, 3 on the right side (upper, middle, and lower) and 2 on the left side (upper and lower).
Generally speaking, lobectomy + hilar mediastinal lymph node dissection is the standard “procedure” for lung cancer surgery and is the treatment most patients receive. Depending on the nature, size, and extent of the lesion, the surgeon may remove part of the lobe or even the entire lung.
After a lobe is removed, will another one grow?
No.
No. A new lobe will not grow after it is removed, but only through exercise, etc., to give the other lobe a chance to increase respiratory compensation.
After a lobe is removed, does a large crater appear in this side of the chest?
Nor does it. We know that the nature of the lung is actually a “balloon” and that the chest can expand or deflate as it undulates. Usually two or three lobes expand at the same time, but if one lobe is missing, the remaining lung tissue, because it has more room to expand, will appropriately “overinflate” a little to fill the pit that remains after resection. In addition, because there is a cavity for a short period of time after surgery, the diaphragm will lift and the contralateral lung will push the mediastinum toward the surgical side, thus filling the cavity. In the case of total lung resection, in addition to the mediastinal shift and diaphragm, a large amount of pleural fluid will fill the chest cavity, thus maintaining the same pressure as the healthy side and ensuring that life-threatening conditions such as mediastinal flutter do not occur.
Will a missing lobe interfere with normal breathing?
The preoperative evaluation is critical, and the recovery of lung function after surgery is closely related to the extent of resection, exercise, and lung base. If the preoperative lung function assessment is tolerable, the impact of lobectomy on lung function will generally be manageable. Patients will have some impact on breathing for a short period of time after surgery (generally 3 months). After surgical resection, the function of ventilation, which used to be performed by five lobes of the lung, now relies on four lobes. For a short period of time, patients will experience chest tightness and shortness of breath. As the other lung lobes gradually compensate up and cooperate with doctors and nurses to do post-operative lung function exercises (such as coughing up sputum, deep breathing, etc.), most people can gradually approach a similar lung function before surgery. Just say, if you used to be able to run a marathon, now your performance is worse; you used to be able to climb 10 floors, now you can only climb 8 floors in one breath. The difference is more or less the same, but your daily life and work will hardly be affected at all. If the whole lung is removed, the impact on lung function will be greater, and a small number of patients will even need a ventilator to help them breathe for a short period of time, and when they recover after surgery, life will generally not be significantly affected, but heavier work and physical work may be more difficult to accomplish.
Who can “hold their breath” after surgery?
Who can hold their breath after surgery?
Of course, some patients may have more breathlessness after surgery.
First, there are patients who have smoked for a long time before surgery and have poor lung function. This type of patient has a low lung capacity and can only climb three flights of stairs, so cutting off one-fifth of the lung tissue may lead to a further reduction in lung function. “The way to remedy this is to strictly stop smoking before and after surgery and stay away from secondhand smoke.
Secondly, patients with tumors that are too close to the center and require removal of two lobes of the lung, or all of one side of the lung. Because there is little or no lung tissue remaining on the affected side, there is no way to adequately replace the resected lung tissue to function, and it has to be replaced by the healthy side. In this case, efforts are made to avoid infections and smoke, etc., after surgery, even though pneumonia can be extremely disruptive.
As the saying goes, the cure is “three parts treatment, seven parts nourishment”, but for post-surgical recovery from lung cancer, doctors require “three parts treatment, seven parts practice”. Appropriate activities and exercises can not only promote lung reopening and sputum removal, but also promote the absorption of pleural effusion and help remove the drainage tube as soon as possible. After discharge from the hospital, doctors also recommend maintaining appropriate activity to encourage an early return to community-based physical activity and even a return to work.
Do you feel a little more relaxed after reading these questions and answers? You can also talk to your patients who have had surgery and know that you won’t have the “gasping for air” that you thought you would have, so you can have the confidence and courage to face the surgery.
Co-reviewed by: Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute Xie Liang, deputy chief physician Dr. Zheng Shaopeng
Co-authors: Dr. Wang Xing, Peking University Cancer Hospital