Lung resection varies in the amount of lung resected and the approach, and ranges from segmentectomy or wedge resection to lobectomy or pneumonectomy. It may be performed using a minimally invasive technique (video-assisted thoracoscopic surgery [VATS]) or via a thoracotomy. Irrespective of the type of resection undertaken or approach chosen, the aim is to have the patient extubated, breathing spontaneously and able to cough and expectorate secretions with minimal discomfort as soon as possible after the procedure.
Thoracic surgical patients often have significant comorbid conditions. The association between smoking, emphysema, lung cancer and cardiovascular disease is widely accepted. The preponderance of comorbid disease, together with the extent of surgery and the surgical approach, predispose to numerous potentially serious complications.
The aim of preoperative assessment and optimization is to identify patients at risk of complications and to take measures to prevent such complications from arising. Good postoperative care aims not only to recognize and treat complications that have already occurred, but also to prevent the progression from minor to major complication.
Mortality after lung resection has generally improved over the years with improved diagnostic and treatment strategies. The 30-day mortality rate for lung resection is between 4% and 5% and is inversely proportional to the experience of the surgical centre. Pneumonectomy carries a higher mortality risk compared with lobectomy, which in turn carries a higher mortality rate than wedge lung resections.