Everyone has two lungs - a right and left lung. These lungs are divided into lobes, three on the right and two on the left. The lobes on the right are called the upper, middle and lower lobes. The lobes on the left are called the upper and lower lobes. Within each lobe they are also further divided into segments. Each segment has its own blood and air supply.
The lungs exist in your chest and are wrapped by two thin layers called pleura. The pleura overlying your lungis called the visceral pleura, the pleura attached to the chest wall is called the parietal pleura. Between these two pleura there is pleural fluid, a lubricant that helps your lung move within your chest.
Both lungs are connected to your nose and mouth via your windpipe. Your windpipe starts off as the trachea in your neck and as it goes down towards your lungs, divides into bronchus. These carry air from outside your body into your lungs for oxygen to be absorbed and carbon dioxide to be released.
Like all organs in your body, there are lymph nodes within and around the lung. These are mainly distributed along the bronchus.Your lungs lie in close relation to your heart and the space between the lungs are called the mediastinum. It is for this reason thoracic surgery has its specific risks as our surgeons operate close to your vital organs.
Depending on the location of your lung lesion, the surgeon would recommend an appropriate surgery to cleanly remove the lesion and ensure no cancer cells get left behind. To do this, they must not only take the lesion but a sufficient part of the lung either along the divisions (lobes and segments) or with a wedge resection.
In addition to removing the lung, if there is suspicion of cancer, your surgeon will remove the surrounding lymph nodes to check for cancer spread to these areas. This will help remove early spread of cancer cells to these lymph nodes and help the surgeon accurately stage the cancer.
Lung surgery is performed under general anaesthesia and there are many approaches possible. Your surgeon will discuss with you the optimal approach to facilitate the safe removal of the disease. Here are some common methods of performing lung surgery:
Your surgeon will advise on the potential risks of surgery specific to you. In general, here are some of the common risks:
In order to safely perform the surgery, your surgeon will arrange necessary tests for you prior to the surgery. This may include blood tests, additional scans, heart and lung tests to ensure that you are fit to undergo surgery. You will also be seeing the anaesthetist prior to the surgery to better understand the anaesthesia plan for that day. They will also advise on the necessary medications to omit prior to surgery.
You will be contacted one working day prior to the surgery date to receive final instructions on what time and where to report. For most cases, you are allowed to admit on the morning of the surgery so you can get a good night’s rest at home the day before.
In the lead up to surgery, you are advised to continue exercising to build your stamina and eat more to increase your body’s nutrients. Please do not take traditional medications before and after surgery as they will often lead to unexpected complications such as bleeding
It is normal to feel nervous on your surgery day. You will be brought to the operating theatre and the team will check on you multiple times before administering anaesthesia. You will not be aware or feel any pain once you are under general anaesthesia.
When you wake up, it is normal to feel tired and drowsy. You will likely be in the recovery area [Post-Anaesthesia Care Unit] for observation before being brought to the ward. If you are in pain, please tell us so that we can help you with it. It is advisable to prop yourself up at least 35-40 degrees to assist with breathing and to cough up phlegm, if any, to facilitate recovery.
On the first Post-Operative Day (POD), a physiotherapist will be assisting you with mobilization and deep breathing exercises.
There will be a chest drain coming out from you to drain the remaining fluid and air within your chest. This will be connected to a box which the doctor will check daily to determine your progress and recovery. Once it is safe, the chest drain may be removed on POD Day 1 – 3.
In some cases when you have persistent air leak after surgery, the chest drain may be kept and connected to a one-way valve called a Heimlich bag. Caregiver training will be provided upon discharge and you will be reviewed in the clinic weekly to assess the removal of the drain.
After your chest drain is removed, please follow the discharge post-op care listed below:
1. Wound care
2. Signs & symptoms of wound infection as follows:
Call your Thoracic Nurse or Case Manager (office hours 9am - 5pm) regarding surgical wound and pain management.
Name card will be provided.
3. Self recovery at home
Incisions
You may continue to experience itchiness or tingling sensations and pain in the chest around the incision area for about 6 months. It may take up to 1 year for the itchiness/tingling sensation to be reduced.
4. Medication adherence
5. Importance of early exercise and return to physical activity
6. Lifestyle and diet modification
Depending on various factors such as the size, the extent and the spread ofthe cancer, it will be assigned a stage. We currently use the 8th edition of lung cancer staging to stage lung cancers. Based on the characteristics of your cancer, your surgeon will explain to you what stage you are.
