Pulmonary Resection

About Your Surgery

Throughout your treatment, you will follow a specific plan of care, which will depend on your individual diagnosis. This information provides an overview of your care path. Although this material covers standard procedures, each patient receives individual care.

Your doctor recommends that you have all or part of a lung removed (pulmonary resection). This surgery is done through an operation called a thoracotomy. As technology has improved, many lung operations today can be done using a "minimally invasive" approach known as thoracoscopy. With this type of surgery, visualization into the chest is provided by a video camera attached to a small scope and the surgeon operates through small "port" incisions. This results in less post-operative discomfort and a quicker recovery.

For a thoracotomy, the surgery is done through an incision on the side of your chest. The kind of surgery that you have and how much lung tissue needs to be removed will depend on the location of the cancer in your lungs. Most lung surgery patients are hospitalized for 4-5 days.

Although this booklet covers standard procedures, each patient receives individual care. Your preparation for surgery will be determined by your doctor.

Your Health Care Team

Many different health care specialists will take care of you during your treatment. Your team may include several doctors and nurses, your family, and others. Sometimes you may feel overwhelmed. Please talk with your team members about your surgery. They are here to help with any needs or concerns that you may have.

Smoking

You may not smoke before or after surgery. If you are a smoker, you should quit smoking at least 2 weeks before surgery. If you smoke, you are more likely to have medical problems, such as pneumonia, after your surgery.

Programs are available to help you and/or your loved ones to stop smoking. For more information, ask your doctor or nurse.

Preoperative Tests

Before lung surgery, most patients go through quite a few tests. These tests will help your doctor determine if a tumor can be removed surgically. They will also help your doctor assess the degree of risk involved with surgery, particularly from the point of view of your heart and lung function. Some of the tests you may have include:

Chest xray: Computerized tomography (CT) scan of the chest and upper abdomen: a test in which a computer uses xrays to create threedimensional (3D) pictures of the body. This scan will show your doctor the size and location of a tumor to help plan surgery.
PET scan: This is a nuclear medicine scan which can help determine if a lung mass is cancerous and if there is any spread beyond the lung.
Blood tests
Pulmonary function testing: a diagnostic test to measure the amount of air flowing into and out of the lungs, and to determine how well the blood is receiving oxygen.
Electrocardiogram (ECG): If you have a history of heart problems or if you have any abnormalities on your ECG, your doctor may want to undergo more testing of your heart function.

During your pre-operative tests, you will also see an anesthesiologist. This doctor will talk to you about the anesthetic that you will receive during surgery. Most lung surgery requires a general anesthetic, where you will be completely asleep during the surgery.

Before Surgery

To help prevent possible complications while you are asleep under anesthesia:

Do not eat or drink anything after midnight the night before surgery.
You may brush your teeth and rinse your mouth with mouthwash. Just avoid swallowing any water or mouthwash.
If you are taking medications, your doctor may allow you to take them with a small amount of water. Talk to your doctor or nurse about taking any medications before surgery.

Preparing Your Skin

You may want to wash your hair the night before surgery because you may not feel like washing it for several days afterwards. After you have washed your hair, take a shower or bath. Carefully wash your chest, neck, and underarms. After your shower or bath, do not put anything on your skin – not even deodorant.

Packing

Bring the following items with you to the hospital:

these educational materials;
basic toiletries, such as a comb, toothbrush, and toothpaste;
slippers and a robe.

Do not bring credit cards, money, or jewelry. If you do bring valuables, ask family or friends to keep them until you return to your hospital room after surgery. If no one is able to help, ask the nurse to store your valuables. The hospital can not be responsible for any lost valuables.

Day of Surgery

Getting Ready for Surgery

Report for surgery as you were instructed.

You will be helped onto a stretcher and moved to the holding area, a patient waiting room near the operating room
Put on a hospital gown. It is the only thing you can wear to the operating room.

Do not wear anything that can come off during surgery, such as dentures or partial plates, eyeglasses or contact lenses, jewelry, bobby pins hair clips, wigs, or any removable prosthesis, such as an artificial eye or leg. Go to the bathroom and empty your bladder.

In the Holding Area

You may be given medicine to help you relax. A blood pressure cuff will be put on your arm.

An intravenous (IV) will be placed in a vein in your hand or arm. An IV is a small tube inserted into a vein, through which you receive medicine and fluids

A nurse will ask you questions to verify any drug allergies or to discuss concerns you may have. You will also be asked several times to verify your name and what procedure you are having. If you are having lung surgery you will also be asked which lung, right or left, is being operated on. These questions are to help insure that the correct patient gets the correct operation and no mistakes are made.

You may have an epidural catheter placed in your back by the anesthesiologist. This is used to help control pain after surgery.

There is a lot of preparation that takes place before a major chest operation. It may be an hour or more from the time you are taken from the holding area until your surgery actually starts.

In the Operating Room

You will come into the operating room on a stretcher. A nurse will help you move to the operating table. If you feel cold, ask for a blanket. Your family and friends may stay in the surgery waiting area. They are not allowed in the operating room. Staff will be wearing uniforms, masks, and caps. An ECG machine will monitor your heart rate. You will receive the anesthetic through your IV. After you are asleep, a tube will be put in your throat to help you breathe.

After Surgery

You will begin to wake up in operating room and the breathing tube in your throat will be removed. You will then be taken to the recovery area or Post-anesthesia Care Unit (PACU) where you will completely wake up. A protective lubricant is put in your eyes while you are in the operating room, so you may not see clearly when you first wake up. This is normal and lasts only a short time.

Your mouth probably will feel dry, and you may have ice chips. You may have a sore throat for a day or two.

Your family will not be able to visit you while you are in the PACU, but they will be able to see you later, in your room. Most patients spend between 1-3 hours in the PACU before going to your room. Some patients will spend the first post-operative night in the Intensive Care Unit (ICU) where you can be monitored more closely.

You May Have:

a Foley catheter: This is a rubber tube placed into the bladder to continually drain urine. It is placed in the operating room after you are asleep and is usually left in for a few days after surgery.
an IV (intravenous line for fluid and medications)
One or more chest tubes: These are tubes placed into the chest cavity during surgery to drain fluids that may surround the lungs after surgery. These tubes also help keep the lung expanded by removing any air that may be leaking from the lung. Chest tubes are usually removed 3 to 5 days after surgery, when the fluid drainage decreases and air leaks are sealed.
Pneumatic compression stockings: These are plastic stockings that are placed on your legs in the operating room before the start of surgery. They inflate with air every few minutes, gently squeezing your legs. They are used to help prevent blood clots in the veins of your legs during and after surgery. They will be kept on, particularly while you are in bed, for 3 or 4 days, or until you are up walking.
Sutures or metal clips (called "staples") to hold the edges of your incision together. Some sutures will dissolve. Other sutures and staples will be removed in 5 to 10 days.

Tell your nurse if you have pain or nausea. Medicine may help to relieve these problems.

That Evening:

With assistance, you will sit on the side of your bed.
You may have ice chips and sips of liquids.
If you are in pain, ask your nurse for pain medication.

The Morning After Surgery:

You will be helped out of bed to sit in a chair.
You will be able to resume eating a normal diet.
Most patients are transferred out of the ICU to a regular hospital room the day after surgery.

Recovery

Each Day of Your Hospital Stay

Your doctor will check your progress.

Your doctor or nurse will check your lungs, your IV site, your incision site, and the drainage tubes in your chest.

Drainage from your chest tube(s) will be monitored. When the amount of drainage becomes low enough, the chest tube(s) will be removed.

You will receive an aerosol (mist) breathing treatment 4 to 6 times per day. This treatment contains a medication to help open up your bronchial tubes and loosen mucus, making it easier to cough up and clear your lungs.

Get out of bed and gradually increase physical exercise. Walk as much as you can to help prevent pneumonia and the formation of blood clots in your legs. You will be a bit short of breath initially, but this will improve as your recover.

You will have chest X-rays taken every few days, if needed. These X-rays give your doctor information about how your lungs are recovering from surgery.

Breathing & Coughing Exercises

These exercises are very important. They help prevent complications, such as pneumonia, after surgery. Use the incentive spirometer every hour. This will help you take deep breaths, keeping your lungs expanded. Your nurse will show you how to do "splinting," using a pillow or folded blanket to support your chest. This will make the breathing and coughing exercises less painful.

Pain management: Pain control after a major chest operation is extremely important. Adequate pain relief will allow you to cough and deep breathe effectively and get out of bed to move around. You will receive pain medicine through a PCA pump or a temporary epidural catheter. You must tell your nurse if pain interferes with your ability to walk or do the breathing and coughing exercises. Your dose of medicine can be adjusted to make you feel more comfortable.
PCA (Patient Controlled Analgesia) pump: a pushbutton pump that provides small continuous doses of pain medicine. By pushing the button, you control when you get a dose of medication. You do not have to call the nurse and ask for pain medication. A small computer in the pump is programmed for the dose of medication and the time interval between doses, so you can't give yourself too much medication. Morphine or Demerol are the usual drugs given through a PCA pump.
Epidural catheter: Most patients undergoing a major chest operation have an epidural catheter. This is a small tube inserted in your back by the anesthesiologist. Although it is used for pain control after your surgery, it is usually placed in the holding area before surgery. You receive a continuous dose of pain medicine through the epidural catheter. It is very effective controlling the pain after surgery and is usually left in for three or four days. The medicine blocks the pain signals normally carried to your brain. A continuous flow of medicine provides constant pain relief. You never have to wait for nurse to give you a shot. The anesthesiologist will visit you daily to determine how well your pain is being managed.

Home Care Discharge Instructions

Your Breathing

Many people find that they are a bit short of breath after a chest operation, particularly with exercise or activity. This will improve as you recover.

Keep coughing! Most people have some extra mucus or phlegm after a chest operation, especially if you are a smoker. Coughing and deep breathing will help clear it out and prevent problems such as pneumonia. The phlegm will usually be clear, but it's not unusual to have some streaks of blood for a few days. If you cough up a lot of blood, if the blood is bright red, or if the mucus is brown, greenish, or foul smelling, call your doctor. Holding a pillow or folded blanket against your chest may help relieve some of the pain or pressure that your feel when coughing.

Do not smoke at all after the surgery. Smoking cessation programs are available. Ask your doctor or nurse for more information.

Pain

You can expect to have some discomfort after your operation. You will be given a prescription for pain medication when you go home and we encourage you to use it. It is important to have adequate pain relief so you are able to cough and deep breathe effectively and get up and move around. You may also use ibuprofen (Motrin, Advil) to supplement the prescription pain medication. The prescription pain medication often causes constipation. Drink plenty of fluids to help prevent constipation. If necessary, take a laxative of your choice. Do not drink alcohol as long as you are taking pain medicine.

As you heal, you can expect the pain to gradually subside and eventually disappear. After a week or two, you will probably be able to stop the prescription pain medication. You may also notice some numbness or a burning-type sensation in the area of your incisions. This is also normal and will gradually disappear.

Activity

You are encouraged to be as active as you feel comfortable being. You may feel fatigued and tire easily, but as you recover you will regain your strength and stamina.

You may do as much walking as you feel comfortable doing. It the weather permits, you may take a walk outside. Your breathing may be a bit more difficult it if is bitter cold or very hot and humid, and remember: as far as you walk, you'll have to walk that far to get back home! You may go up and down stairs if you need to; be careful not to lose your balance. You should avoid using an exercise bike or a treadmill until your incisions are healed.

Gently exercise your arm and shoulder on the side of your operation. You may feel a tightness or pulling in the area of the incision, but gentle stretching will not tear anything apart. Avoid strenuous exercise or heavy lifting until you are completely healed. In about 6 to 12 weeks, you should be able to use your arm and shoulder as you did before surgery.

You may ride in a car, but you shouldn't drive for several weeks. When you are no longer taking prescription pain medication and movement of your arms and chest is not limited by pain, it is safe to drive. Eat a balanced diet.

A decreased appetite is normal for a period of time as you recover. If you are not able to eat well, drink supplements (such as Ensure) or milk shakes. Resume sexual activities whenever you wish.

Care of Your Incisions

When you go home, your incision will generally not need any dressing or bandage and can be left open to air. There will usually be a bandage over the incision where your chest tube was removed. There may be some drainage from the chest tube incision for a few days after the tube is removed. The fluid draining is usually yellow or pink and will usually stop in a few days. Keep a dry gauze bandage over these wounds until the drainage stops. If the dressings become saturated, they can simply be changed. Once the drainage stops, a scab will form and the dressings are no longer needed.

You may shower when you go home. Your incisions may be gently washed with soap and water. If you have metal clips in your incisions, it's okay to get them wet (they're stainless steel and will not rust). The clips will be removed at your follow-up visit a week or two after discharge. If you have tape strips on your incisions, these may be gotten wet also; they will peel off on they're own, usually in a week or two.

Call your doctor if redness, swelling or tenderness develops in the area of your incisions, drainage from the incisions looks like pus.

Follow-up

After you are discharged from the hospital, call your doctor's office for a follow-up visit. Your doctor will usually want to see you 10-14 days after discharge. Your doctor may want you to have a chest X-ray the day before or the day of your follow-up visit. This X-ray can be compared to the one you had in the hospital to check how your lungs are recovering from surgery.

If you have any problems or concerns, call your doctor's office. To schedule appointments or for routine questions, please try to call during our regular office hours, 8:00 AM to 5:00 PM, Monday through Friday. If you have a serious problem or an emergency, don't hesitate to call, someone is always available.