Sleeve resection

What does sleeve resection involve?

During surgery you lie on your side with your arm raised. Open surgery is done with one cut under the shoulder blade, the incision goes between two ribs. The two ribs are parted to get into the chest. One rib may be cut to give more space, ribs are not removed.

The blood vessels and bronchus leading to the lobe to be removed are identified. The part of the airway or blood vessel with tumour growing in it is identified and cut either side of the tumour, this section is removed along with part of the lung. The two cut ends are then stitched back together. Special staples are used to cut and seal the blood vessels and bronchus that do not have tumour growing in them.

Lymph glands will also be removed. At the end of surgery the two ribs are held back together with strong stitches. The muscles and skin are closed with stitches. One or two chest drains are put in at the end of the operation and held in place with a stitch. These remove any fluid or air from around the lung.

What is recovery like?

Recovery in hospital and recovery at home apply to sleeve resection. Most people go home between five and seven days after surgery. Everyone recovers at a different pace, do not worry if you need more time.

If part of a blood vessel has been stitched back together you may need medication to thin the blood temporarily.

If part of the bronchus has been stitched back together extra care will need to be taken in clearing mucus from the lung to avoid blockages at the connection point.

What are the risks?

Possible complications  of thoracic surgery apply to sleeve resection.

In addition the following are risks of sleeve resection:

Minor more common risks

Air leaking from the lung into the chest drain for a few days is common after lung surgery. Occasionally this lasts for longer, possibly weeks. A chest drain will need to be in place until this settles, you may be able to go home with the chest drain still in and come back for regular check-ups until the air leak settles.

Your kidneys may not work as well after surgery but this is usually temporary and gets better with extra fluid.

Major less common risks

Some people are more short of breath after surgery. Part of your preop assessment is assessing your risk of being breathless after surgery. If you already have lung disease there is a higher risk of being breathless, including needing to have oxygen at home.

Shortness of breath may severe enough to require help from a ventilator machine. This can be with a face mask with you fully awake. It may also be need via a tube in your windpipe with you under sedation. If you need help breathing via a tube for a long time it may be better to have a temporary tracheostomy. This is a tube put in through the neck which is removed once breathing improves.

A hole may form near the staples (bronchopleural fistula), this is usually only happens with an infection. It causes air to keep coming out of the lung but can be difficult to diagnose.

You may need antibiotics and another operation to fix the hole.

Fatty fluid may collect in the chest (chyle leak), it is rare. You may require a temporary change in diet, a chest drain  or another operation to treat this.

Nationally 97 in 100 people are alive one month after surgery and three people die. Your individual risk may be higher or lower depending on your health.

What are the alternatives to surgery?

Surgery gives the best chance of being free from cancer if you have early stage lung cancer. You can discuss treatment options with your hospital doctors, your lung cancer nurse and your GP. If you do not want surgery or are not well enough to have an operation other options may include:

• radiotherapy
• chemotherapy
• palliative care

It is your choice whether to go ahead with surgery or choose another kind of treatment. We will respect your wishes and support you in choosing the treatment that suits you. You are always welcome to seek a second opinion.