A lobectomy is the removal of a lobe of one of the organs, usually referring to the brain, the lung, or the liver.
Purpose
Lobectomies are usually performed to prevent the spread of cancer from part of one organ to other parts of the organ or other parts of the body. Lobectomies are also performed on patients with severe seizure disorders (such as some forms of epilepsy) to prevent further seizures. However, there are differences in each of the three organs on which lobectomies may be performed.
Description
The brain
Each lobe of the brain performs a different function, and when part of the brain is removed, it does not grow back. However, other parts of the brain can take over some, or all, of the function of the missing part of the brain. Depending on the part of the brain removed, the effects may be quite severe, or nearly nonexistent.
The most commonly referenced brain lobectomy in the medical literature is the removal of the temporal lobe. Temporal lobectomy is usually performed to prevent debilitating seizures. Seizures are commonly caused by temporal lobe epilepsy, but can also be caused by brain tumors in the temporal lobe. Thus, lobectomy of the temporal lobe in patients with a temporal lobe tumor reduces or eliminates seizures, and has the beneficial side effect of removing the tumor mass.
The lung
Lobectomies of the lung are also called pulmonary lobectomies. Each part of the lung performs the same function: it exchanges oxygen for carbon dioxide in the blood. There are many different lobes of the lung, however, and some lobes exchange more oxygen than others. Lobes of the lung do not regenerate after they are removed. Therefore, removal of a large portion of the lung may require a person to need oxygen or ventilator support for the rest of his or her life. However, removal of a small portion of the lung may result in very little change to the patient's quality of life. A test (a quantitative ventilation/perfusion scan, or quantitative V/Q scan) may be used before surgery to help determine how much of the lung can safely be removed.
The outcome of lung lobectomies also depends on the general health of the entire lung; emphysema and smoking would have a negative impact on the health of a patient's lung.
The liver
A lobectomy of the liver is also called a hepatic lobectomy. The liver plays a major role in digestion, in the transformation of food into energy, and in filtering
and storing blood. It processes nutrients and drugs, produces bile, controls the level of glucose (sugar) in the blood, detoxifies blood, and regulates blood clotting. Unlike the brain and the lung, the liver may regrow, or regenerate, after part of the liver has been removed. In addition, since every part of the liver performs the same functions, the liver is the organ whose function is least likely to be severely affected by lobectomy, in the long term, because it regenerates. However, as the liver is central to the body's functions, removal of too much of the liver at once may result in coma or death.
Precautions
Brain lobectomies should not be performed unless the patient has been unable to control seizures through medication. Additionally, the seizures must be caused by a single, relatively small, localized part of the brain that can be resected without severe damage. Lung lobectomies should only be performed on patients with early stage non-small cell carcinoma of the lung, or as part of a combination of therapies at later stages. Since even a "complete removal" of the tumor does not result in an overwhelming survival rate after five years (see normal results), other therapies may also be considered. Small cell cancer of the lung does not respond to surgical intervention. Patients with liver disease that is too extensive may need a liver transplant rather than a liver lobectomy. Patients with blood clotting problems, either due to chemotherapeutic agents or for other reasons, should have these problems addressed before surgery.
Preparation
Before surgery, patients should not take aspirin or ibuprofen for one week. Patients should also consult their physician about any blood-thinning medications such as coumadin or warfarin. The night before surgery, patients will usually be asked not to eat or drink after a certain time.
Aftercare
Each surgery offers different aftercare challenges. Patients may need to be hospitalized for some time after the operation. Patients with portions of their brain removed may require rehabilitation of a physical, mental, or emotional nature depending on the portion of the brain that has been removed. Patients who have had portions of their lungs removed will probably require a tube in their chest to drain fluid, and may require a machine to help them breathe. They may also require oxygen, either on a temporary or permanent basis. Patients who have had hepatic lobectomies may also have drainage tubes, and may also have initial dietary restrictions. Physicians should be consulted for the specifics of aftercare in each individual situation.
Risks
Specific risks vary from surgery to surgery and should be discussed with a physician. In general, any surgery requiring a general anesthetic may, uncommonly, result in death. Improperly performed brain surgery may result in permanent brain damage. Depending on the surgeon and the size of the tissue removed, patients may be at risk for some types of brain damage. As previously mentioned, patients having part of a lung removed may have difficulty breathing and may require the use of oxygen. Patients may also experience infection (pneumonia), or blood clots. Liver resection (surgery) may result in the following complications: coma, slow return of normal bowel function, and biliary leakage.
Normal results
Most patients who undergo temporal lobectomy experience few or no seizures after surgery (some estimates range from about 70% to about 90% success rate). Unfortunately, lung lobectomy is not as successful. 50% of cancer patients with completely removable stage I non-small cell cancer of the lung survive five years after the procedure. If the cancer has progressed beyond this stage, or if the cancer is not completely removable, the chances for survival drop significantly. The results of liver resection vary. The possible outcomes of each surgical type should be discussed with the patient's physician. Generally, the less severe the cancer, and the less tissue that needs to be removed, the better the outcome.
Abnormal results
Abnormal results vary from operation to operation and should be discussed thoroughly with the patient's physician before surgery. Patients who undergo temporal lobectomy may, rarely, die as a result of the operation (a
complication in less than 1% of patients). Patients may also have problems with their vision, or problems with speech. Abnormal results from the removal of part of the lung could include pneumonia or blood clots (which may result in stroke, heart attack, or other problems) after the surgery. Also, a small percentage of patients undergoing lung lobectomy die during or soon after the surgery. The percentage of patients who suffer death varies from about 3% to 6% depending on the amount of lung tissue removed. Finally, abnormal outcomes from liver resection can include coma, death, and problems with liver function.
Resources
BOOKS
Braunwald, Eugene, et al. Harrison's Principles of Internal Medicine, 12th Edition. New York: McGraw-Hill, Medical Publishing Division, 1991. pp. 1106-1108.
PERIODICALS
Tatum, W. O., S. R. Benbadis. "The neurosurgical treatment of epilepsy." Archives of Family Medicine 9(10) (Nov-Dec, 2000):1142-1147.
OTHER
Harrison's Principles of Internal Medicine online, Chapter 90: Neoplasms of the lung. <http://www.harrisonsonline.com/>.
Koike, Atsushi, M.A., Hiroyuki Shimizu, M.D., Ichiro Suzuki, M.D., Buichi Ishijima, M.D., and Morihiro Sugishita, Dr. H.S., Dr. M.S. "Preserved musical abilities following right temporal lobectomy." Journal of Neurosurgery (December 1996). 24 July 2001 <http://www.c3.hu/~mavideg/jns/1-4-prev1.html>.
Michael Zuck, Ph.D.
QUESTIONS TO ASK THE DOCTOR
What benefits can I expect from this operation?
What are the risks of this operation?
What are the normal results of this operation?
What happens if this operation doesn't go as planned?
