Information about Your Lung Operation

Information about Your Lung Operation

Contents Introduction 2 Page What operation might I need? 2 Before your Operation 4 The Night before your Operation 6 The Day of your Operation 6 After your Operation 7 Preparing to leave Hospital 11 At Home 12 Further Treatment 15 Useful contacts and telephone numbers 16 1

Introduction You have been offered an operation on your lung. This aims to remove either a lung cancer or a suspicious area from which a sample of tissue (biopsy) has not yet been taken. In a small number of people the suspicious area will turn out to be something other than cancer. This booklet will explain what will happen to you during your stay in hospital. It will also give you advice and information for your recovery after your operation. You will be given further information as you go along. The surgeon will discuss your particular operation with you and the reason you need this operation. Your care will be tailored to meet your needs. If you have any questions please ask. What operation might I need? There are various types of operation, depending on the size and position of your tumour or suspicious area. Lobectomy - The lungs are made up of sections called lobes. The right lung has 3 lobes and the left lung has 2. If the cancer or suspicious area is in only one lobe, a lobectomy may be carried out to remove the entire lobe. A bi-lobectomy is the removal of 2 lobes in the right lung. Pneumonectomy - This is removal of an entire lung. This is recommended if the cancer or suspicious area is in the centre of the lung involves both lobes of the left lung involves all 3 lobes of the right lung. People can function well with only one lung. 2

If your breathing tests show that you cannot cope with having a whole lobe removed you may have a wedge resection, segmentectomy or sleeve resection. Wedge resection or segmentectomy If the tumour is very small and confined to one area of the lung, a wedge resection may be carried out. This removes the affected piece of lung tissue and a margin of normal tissue around it. If a larger section needs to be removed then a segmentectomy is performed. Sleeve resection - This is removal of a lobe and part of the main bronchus. The healthy ends of the bronchus are re-joined and the remaining lobe/s are re-attached to the bronchus. However only a small number of people will be suitable for this type of operation. At any of these operations the surgeon will probably take samples of the lymph nodes (glands) which lie in the centre of the chest near the lungs. The part of the lung which was removed, along with the lymph nodes, are then sent to the laboratory for testing. This diagram shows you how the lungs are made up. Trachea (Windpipe) Upper Lobe Upper Lobe Right Main Bronchus Left Main Bronchus Middle Lobe Lower Lobe Right Lung Lower Lobe Left Lung 3

How is the operation carried out? The operation is carried out under general anaesthetic (you will be asleep during the operation). The procedure used is called a Thoracotomy. A Thoracotomy is used to diagnose or treat a variety of conditions, however lung cancer is the most common reason. The exact location of the thoracotomy depends on the size and position of the tumour. This involves making a cut in the side of the chest between the ribs. The ribs are spread apart to allow the surgeon to see into the chest cavity. A small piece of rib may be removed to make it easier for the surgeon to operate. The wound and chest area may be painful for several weeks to months after surgery. You will be advised on pain relief and exercise to help you to manage this. Smoking If you are still smoking, it is advisable to stop at least 2 weeks before your operation. It is very important that you do not smoke after a lung operation. It can complicate your recovery. Stopping smoking will also give you the best chance in the future. If you need help to stop smoking, there are contact numbers at the back of this booklet. Before your Operation You will usually come into hospital the day before your operation. You may have: A chest x-ray A tracing of your heart (ECG) Breathing tests Blood tests You may have had some of these done already. These are done to make sure you are well enough to have the operation. 4

The tests you have had before surgery have shown that you should be able to lead a reasonably normal life after lung surgery but you may find you are a bit short of breath at times. A doctor or nurse will ask you some routine medical questions and examine you. The doctor will also explain the operation and ask you to sign a form (consent form) to show that you understand and agree to your operation. You will see the surgeon or a member of their team who will explain the operation. Please feel free to ask any questions you may have. The anaesthetist (doctor who puts you to sleep) will come and see you to explain what they are going to do. They will also discuss what type of pain relief you will have after your operation. You will see the physiotherapist who will tell you about exercises that you need to do after the operation (e.g. deep breathing exercises and leg exercises). They will see you every day after your operation to assist you with these exercises and help you get back on your feet again. The ward nurses will ask you some routine questions and explain about your operation and recovery. Your Family When you come in to hospital your family may be shown the High Dependency Unit where you will be after your operation. They will also have the chance to ask any questions. There is a direct line telephone number for the High Dependency Unit and the ward. These numbers can be obtained from a member of staff. It would be very helpful if only one member of your family makes enquiries about your progress by telephone, and then passes this information on to the rest of the family. This helps reduce the time spent answering the telephone and increases the time the nurses can spend with the patients. 5

Only short visits by close family are advisable for the first two days because you will tire very easily after your operation. It is important that you rest to help your recovery. The Night Before Your Operation If you have any valuables, money or jewellery, ward staff will lock them away for safe-keeping while you are in the operating theatre. If possible it is better to send them home. You will have a bath or shower the night before your operation. A nurse will help you if required. Usually you will have nothing to eat or drink for a number of hours before your operation. A nurse or the anaesthetist will tell you when you have to stop eating and drinking. You may be given a sleeping tablet to help you get a good night s sleep before the operation. The Day Of your Operation You will be given stockings to wear to reduce the risk of clots in your leg veins. Staff will advise you on how long you need to wear them, usually it is until you are up and about as normal. You will also be given a theatre gown. You will put these on before you go to theatre. A nurse will help you if required. You will be given a pre-medication (pre-med) usually about one hour before the operation. This will either be a tablet or an injection which will help you to relax before the operation. This may make you feel sleepy but does not put you to sleep. When it is time for your operation, you will be taken to the theatre area. A nurse will then ask you some routine questions and take you through for your operation. The anaesthetist will put a needle into a vein in your hand. Through this needle you are given the drugs which will put you to sleep for the operation. 6

The operation can take up to 4 hours. When you wake up after your operation, you will be in the theatre recovery room. You will stay in theatre recovery until you are more awake. Then you will be taken to the High Dependency Unit. After Your Operation The doctors will see you every day to check how you are getting on. You will also see the surgeon regularly. If you have any questions, please feel free to ask the doctors or nurses. You will be nursed in the High Dependency Unit for about one to three days depending on your progress. In the High Dependency Unit you will be attached to monitors that check your heart, blood pressure and breathing. The monitors regularly make noises to show that they are working properly. The High Dependency Unit has more staff to patients than a normal ward. This is because of the increased care you require in the first few days after your operation. Oxygen You will need oxygen through a face mask or nasal prongs for at least 48 hours. The nurses will gradually reduce this until you no longer need it. Remember to do your breathing and leg exercises. 7

Pain Relief You may have PCA (patient controlled analgesia) which allows you to give your own pain relief when you need it. The PCA machine is set so that you can press the button to receive pain relief regularly. However you cannot get too much pain relief as there is a safety mechanism. So please use this regularly when you are sore, or before moving and coughing. For pain relief you may have an epidural (around the spinal area) or paravertebral block (which involves giving an injection into your upper back beside the spine on the side of your operation). These types of pain relief involve you having a thin tube in your back through which you receive pain-relieving medication. Other forms of pain killer may also be used. Please let the nursing staff know if you are in pain so they can give you something to help. The physiotherapist will show you how to support your wound when coughing. Chest Drains You will have either one or two tubes called chest drains coming from below the wound area. The drains are placed in the chest cavity and extend out through the chest wall and skin through small cuts between the ribs on the side of the operation. They drain any fluid or air from your chest. These tubes drain into a bottle on the floor which contains sterile water. The nurses will check these tubes regularly and you will have a chest x-ray every one to two days to check when they can come out. This varies for each patient. If your whole lung (pneumonectomy) has been removed then the drain/s will come out one to two days after the operation. If part of the lung has been removed the drain/s will be in place for two to seven days or sometimes longer, depending on the result of your chest x-ray. 8

These drains may be attached to suction (a mild vacuum) so this may prevent you from moving around and walking freely. You will be encouraged to walk on the spot and around your bed to exercise and help prevent any complications after your operation. The nurses and physiotherapist will advise you about this. If the drains are not on suction you may be allowed to walk around but you must keep the drain bottle below your chest and keep it upright. If the bottle gets knocked over, please inform the nurses so they can check it. When the drains are ready to be removed you will be given pain relief beforehand to reduce any discomfort. There will be stitches where the drains were. These will be removed after about five days. Other Equipment You may have a drip in your arm and neck after the operation to give you fluids and medications if required. You may also have a fine line (drip) in an artery in your arm for monitoring purposes and taking blood. You will have a tube in your bladder to drain your urine. This will be in place for about 48 hours. Wound Your wound will run from the side of your chest, under your arm and round to your shoulder blade on the affected side. It will be covered with a dressing for the first two days. The nurse will then remove the dressing and possibly leave the dressing off. However, if there is any leakage from the wound a new dressing will need to be applied. The nurses will check your wound regularly and will remove or change any dressings as required. You may have stitches in your wound which will dissolve over time. However if you have any stitches which need to be removed this will usually be done about ten days after the operation. If you are at home by then, it is best to arrange for the practice nurse to remove these at the GP s surgery. If this is not possible, the ward will arrange for the district nurse to come to your home. The ward nurses will discuss this with you before you leave hospital. 9

Eating and Drinking You can eat and drink as you feel able. This can start about four hours after your operation. You would usually start with sips of water and gradually add to this. If you feel sick let the nurses know and they will give you something to help this. You will probably find your appetite will be poor, but try to take fluids and a little food as this all helps with your recovery. Personal Hygiene The nurses will help you get washed for the first few days after your operation, and then you will gradually be able to do this for yourself. The stockings you were given should be changed regularly you may need some help with this at first. Getting up and about again The nurses and physiotherapist will help you get out of bed, usually the day after the operation. You will sit in the chair and will be helped to have a short walk. The distance you walk will be increased each day as you are able. You will be given a heparin injection daily, (to help prevent blood clots forming) usually starting the night before the operation, until you are up and about as normal. This is to help the blood flow freely around your body. You should be able to walk around without help within four to seven days. When in bed it is important that you exercise your legs as shown by the Physiotherapist. This will help your blood circulation. 10

Preparing To Leave Hospital You will be in hospital for five to ten days after your operation. This varies depending on your progress. We understand this can be a worrying time for you and your family so please ask the nurses if there is anything you are unsure of. Before you leave the Ward You would usually go straight home once you have recovered from the operation. Very occasionally you may need to go to another hospital to recover for a short time before you go home. If you have nobody to take you home by car then the hospital will arrange an ambulance. Please let the nurses know if this is the case. You will be given a letter to take to your GP (family doctor) which explains your operation and lists the tablets you have been given. Please hand this letter in to your GP surgery as soon as possible after you go home. A friend or relative may do this for you. You will be given a 7 day supply of tablets to take home. The nurse or pharmacist will explain these to you before you leave. If you need more tablets, you will need to get a prescription from your GP. Remember that your GP may need 48 hours to arrange this for you. An Out-patient appointment will be sent to you to come back and see the surgeon or chest doctor. It is important you attend this appointment to receive the final results of your operation. 11

At Home You will feel quite tired when you first go home but this will gradually improve over the next few weeks to months. You should have somebody at home with you at first if possible. Pain relief You must take your pain relief regularly, especially at bedtime. After a couple of weeks you may feel ready to cut down your painrelieving tablets. Do not cut them down if you are still sore. You may find the pain relief will make you a bit constipated. Try to take a well-balanced diet with extra fruit, vegetables and plenty of fluids to drink as this will help your bowels. You may need to take a laxative. You may have muscular pain in your neck, shoulders, arms and back for up to six weeks after your operation and mild aches and pains for several months. If part of a rib has been removed during your operation you may have occasional stabbing pains. Numbness or tingling along the scar line is also common. If you feel that your pain relief is not working then contact your GP or district nurse. Bathing You can have a bath or shower as soon as you feel able. It is alright to get the wound wet. Gently pat it dry. Do not use perfumed sprays or talcum powder on the wound area until it has completely healed. Wound Your wound may appear a bit swollen. This is normal and will gradually improve. If there is any discharge from the wound or any redness, or if you feel the wound very hot, then please contact your GP or district nurse promptly. It will take six to eight weeks for the wound to heal properly. Try to avoid tight clothing around the wound area during this time. 12

Exercise Everybody recovers at a different pace. Take activity at a gentle pace at first and gradually build up. Walking Walk regularly and gradually increase the distance you go. Start on the flat and work up to slopes and gentle hills. As a general rule it is normal to be comfortably out of breath when you are out walking, but you should always be able to speak. It is important to listen to your body and rest when you are tired. Other suitable exercise may include: For the first 6 weeks: Light housework Light gardening Exercise bike From approximately 6 weeks: Swimming (if your wound is well healed) Carrying shopping Cycling After 8 weeks: Golf Mowing the lawn Badminton Digging If you have had part of your lung removed there can be a change in your buoyancy. So when you first go swimming it may be helpful to take someone with you and have a flotation aid to hand in case you need it. Avoid heavy lifting until at least six weeks after your operation. Keep supporting your wound with a towel or pillow when you cough or sneeze, if necessary. Arm exercises Try these at home every day for the first few weeks. Stretch both arms up over your head Stretch both arms out in front of you Stretch both arms out sideways. 13

Posture It is important to maintain good shoulder posture and avoid hunching your upper body. The physiotherapist will advise you of this. Rest You will feel quite tired when you go home at first. You should plan to gradually increase your activities each week. You should take a rest in bed for an hour or two during the day. Try to make sure that you have a good night s sleep. You may find it easier to sleep sitting upright to help your breathing. Your mood You may find that you feel a bit low in mood some days. You may feel that you are not making progress, or you may have difficulty concentrating or feel very tired. This is normal after an operation. You will have good days and bad days. This will gradually improve as you get your strength back. Work Returning to work depends on how you are feeling and the type of job that you do. If it is light work then you may be able to go back after about six weeks. If it is heavy manual work then it may be longer. You can discuss this with your GP or with your surgeon or chest doctor at your out-patient appointment. Driving Do not start driving until you feel able, which will be around four to six weeks after your operation. Remember that you must be able to do an emergency stop or reverse the car if required. You must also be able to wear a seat belt. At first you would be better to have another driver with you in the car as you may still feel quite tired. Remember your insurance may be affected if you drive while unfit. Check with your insurance company if in any doubt. Travelling Check with your doctor before flying. You should also check with your travel insurer to make sure that you are covered to travel. 14

Alcohol You can take alcohol in moderation but be careful while you are still on medication. Sexual relationships These may resume when you feel able. Remember that everyone recovers at different rates. Further Treatment It is quite common to be offered further treatment once you have recovered from your operation. If this applies to you, the doctors will discuss it with you in the ward or at the out-patient clinic. The hospital/s you are attending participate in clinical trials to try to improve patient care. You may be asked to take part in a clinical trial (study). If so, this would be fully explained to you. Taking part in any trial is voluntary and your care would not be affected if you decided not to participate. 15

Useful contacts and telephone numbers Roy Castle Lung Cancer Foundation Rothesay House, 134 Douglas Street, Glasgow, G2 4HF Helpline: 0800 358 7200 Website: http://www.roycastle.org Macmillan Cancer Support Scottish Office, 132 Rose Street, Edinburgh, EH2 3JD Helpline: 0808 808 0000 (Mon Fri 9am 8pm) for access to benefits helpline and cancer information nurse helpline. Website: http://www.macmillan.org.uk Maggie s Cancer Caring Centres Maggie s, The Stables, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU Tel: 0131 537 2456 Website: http://www.maggiescentres.org British Lung Foundation 73-75 Goswell Road, London, EC1V 7ER Helpline: 08458 50 50 20 (Mon to Fri 10 am to 6 pm) Website: http://www.lunguk.org National Cancer Alliance PO Box 579, Oxford, OX4 1LB Tel: 01865 793566 Website: http://www.nationalcanceralliance.co.uk Services to help you stop smoking Smokeline helpline: 0800 84 84 84 http://www.canstopsmoking.com 16

Local telephone numbers:......

Produced by The Scottish Lung Cancer Nurses Forum in association with: Adapted from leaflet produced by Lynne Flett, Senior Staff Nurse, and Jackie Wattie, Physiotherapist, Aberdeen Royal Infirmary MEDICAL ILLUSTRATION SERVICES To obtain copies of this document, phone 24692 or email info@medill.co.uk Reference No 219883 Review Date: April 2012