INFORMATION FOR PATIENTS WHO ARE PREPARING FOR LUNG RESECTION SURGERY

St James s Hospital Department of Cardiothoracic Surgery INFORMATION FOR PATIENTS WHO ARE PREPARING FOR LUNG RESECTION SURGERY R 255 JULY 2014

CONTENTS Your lungs and how they work...1 Why do I need surgery?...1 LUNG CANCER COORDINATOR The Lung Cancer Coordinator will be able to provide you and your family with support and information. You may have already met your local nurse. However if you have not, you should be able to contact the Lung Cancer Coordinator via the Hospital switchboard. St James s Hospital phone number is 01-4103000. What are the benefits of having lung surgery?...2 What are the risks involved?...2 What operation will I have?...2 Are there any alternatives to surgery?...3 Is there anything I should do before my operation?...3 What do I need to bring in to hospital?...3 What will happen after I get admitted to hospital?...3 What happens before my operation?...4 What happens after my operation?...5 When will I be ready to go home?...7 Will I need further treatment after surgery?...8 What happens when I go home?...8 When will I see the surgeon again?...8 Lung cancer coordinator...9 Useful Contacts...9 This booklet has been prepared to help you and your family understand more about the operation that is planned for you. It will give you general information about what to expect from the time of your admission to your discharge home. However, it is not intended that the booklet will replace talking with medical or nursing staff. USEFUL CONTACTS LUNG CANCER COORDINATORS Phone 087-2146575 or Bleep 101 via Hospital switchboard CARDIOTHORACIC ADVANCED NURSE PRACTITIONERS Phone 01-4103338 MR VINCENT YOUNG S SECRETARY Phone 01-4103534 MR RONAN RYAN S SECRETARY Phone 01-4162323 IRISH CANCER SOCIETY Freephone 1800-200-700 www.cancer.ie DAFFODIL CANCER INFORMATION CENTRE ST JAMES S HOSPITAL Phone 6165604 Email: daffodilcentrestjames@irishcancer.ie 2nd Edition July 2014 9

quite vulnerable, so it is an advantage to have someone at home with you during that time. If you live alone our social worker may be able to arrange additional support for you at home but it may be necessary for you to go to a convalescent centre for a week or two. The nursing staff will talk to you about your plans following discharge when you are admitted for your operation. You will need to organise someone to collect you from Hospital once you are discharged. An ambulance service is only provided if you are being transferred to another hospital. WILL I NEED FURTHER TREATMENT AFTER SURGERY? Following surgery you may need to be referred to a medical cancer specialist (an oncologist) for consideration for further treatment i.e. Chemotherapy or radiotherapy. This will depend on the type of cancer you have and the extent of the disease. The decision regarding the need for further treatment is based on investigations carried out on the piece of lung that was removed. Once available the results of these tests will be discussed by your surgeon, an oncologist and a respiratory physician. A decision regarding the need for further treatment is then made. This process can take up to two weeks to complete, therefore, it is likely that you will be discharged before the decision is made. If this is the case, you will be contacted at home by either the lung cancer coordinator or a Doctor regarding a follow up plan. WHAT HAPPENS WHEN I GO HOME? In general the wounds will be healing without problems by the time you go home. Occasionally there may be a slight discharge from the wound which requires a simple dressing, if this is the case either your GP or a public health nurse will attend to the wound as needed. Following discharge from hospital if there is any redness, pain or leakage from the wound, it is important to report it to your GP or public health nurse so that this can be treated quickly and appropriately. YOUR LUNGS AND HOW THEY WORK The lungs are part of the respiratory system. They make up most of the space in the chest and are separated from each other by the mediastinum. The mediastinum is an area that contains the heart, trachea (windpipe), oesophagus and many lymph nodes. The right lung has three sections, called lobes and is a little larger than the left lung, which has two lobes. The outside covering of the lungs is called the pleura. The lungs add oxygen to blood and remove carbon dioxide. Oxygen is in the air we breathe. Air enters the nose and mouth, travels down the windpipe (trachea) and into the lungs. The lungs also get rid of carbon dioxide, a waste product of the body s cells. You may experience some breathlessness whilst you are carrying out activity. This is acceptable as long as it is not distressing for you. A good way to know if you are overdoing things is to be able to talk at the same time as exercising. The best guideline is to do what you can without becoming too tired or short of breath. Most people find that it takes approximately 3 months after the operation for them to make a full recovery. Obviously there is considerable variation depending on how fit you were before your operation and the type of operation performed. WHEN WILL I SEE THE SURGEON AGAIN? Your surgeon will see you in the Out Patients Department approximately 6-8 weeks after your operation. This appointment may be given to you prior to your discharge or sent through the post. WHY DO I NEED SURGERY? If you are coming to meet a cardiothoracic thoracic surgeon it is likely that you will already have a diagnosis of lung cancer. Lung cancers are generally divided into two types, non small cell lung cancer and small cell lung cancer. Non small cell lung cancer is more common than small cell lung cancer. The cancer cells of each type grow and spread differently. Treatment for lung cancer depends on the lung cancer cell type, size, location in the lungs, extent, individual age, general health and feelings about the treatment. Treatments include surgery, radiation, and chemotherapy. 8 1

Surgery is a procedure that may cure lung cancer in its early stages, if it has not spread to other parts of the body. Your doctor will have discussed with you that the appropriate treatment for your condition is to remove the diseased part of your lung. The amount of lung to be removed will depend on the size, position, type and extent of the cancer. WHAT ARE THE BENEFITS OF HAVING LUNG SURGERY? Your doctor will discuss with you the benefits of having lung surgery. In the majority of cases, an operation is recommended with a view to potentially curing your cancer. WHAT ARE THE RISKS INVOLVED? As with all surgical procedures, lung surgery carries some risks. These risks vary according to the type of operation, your overall health and your individual condition. You will have an opportunity to discuss the risks and the benefits of the proposed surgery so that you have sufficient information to be able to sign the consent form. Some of the risks involved with lung surgery include: Wound infections, bleeding and chest infection. Developing blood clots in the leg (deep vein thrombosis) or in the lung (pulmonary embolism) are other possible risks. A small number of patients experience chronic pain following this type of surgery, we will monitor your pain control carefully when you are in hospital and if chronic pain becomes a problem following discharge home we will refer you to a specialist for further management. Unfortunately, very unusually a patient will develop a serious life-threatening complication following lung operations. The doctors, nurses and para-medics try to prevent and treat such complications. However, for a small number of patients these complications may prove fatal. Thankfully this is very rare. A more precise estimate of the risk will be given to you by your doctor based on your individual case. WHAT OPERATION WILL I HAVE? The main type of surgery used in lung cancer treatment is lobectomy. This involves removing about half of the lung on one side. In about one in five patients it is necessary to remove the whole lung on one side (pneumonectomy). The choice of surgery depends on the size and location of the tumour, the extent of the cancer, and the general health of the patient. Your surgeon will advise you of which type of lung resection he expects to do on you but the final decision will be made at the time of operation. All types of lung operations require a thoracotomy which is an incision into the chest wall. During the procedure the chest wall is opened, ribs are spread apart and the lung is entered to remove the diseased portion. An operation to remove a small part of the lung is called a segmental or wedge resection. 2 you should inform the ward staff. The physiotherapists and nurses will assist you as required. Exercise is encouraged to prevent chest infection, stiffness, bedsores and constipation. In addition to your support stockings, you will also be given a small injection of an anti- coagulant each day, this is a medication to help the blood flow freely and prevent clots from forming. REMOVAL OF THE CHEST DRAINS The chest drains will be removed when they are no longer required, usually this occurs after 3-4 days although sometimes it takes longer, this will be explained to you by the doctor. Prior to removal of your chest drains you will be given additional pain relief. Once removed, you will have a stitch at each drain site, this will be removed after 7 days. If you have been discharged home before this we will arrange for a public health nurse to remove the stitches. YOUR WOUND Most patients having chest surgery have a wound that extends from just under the shoulder blade, around the side of the chest to under the armpit (see picture). Following your operation the nurses will check your wound daily until you leave hospital. EATING AND DRINKING Initially your appetite may be poor, so try to drink and eat a little when you can as this helps with wound healing. The dietician will offer nutritional support if required. CONSTIPATION Constipation can occur following any type of surgery. This is Picture shows thoracotomywound and two chest drains due to the effects of the anaesthetic and the pain relieving medication you need to take post operatively. To help prevent constipation try to eat a well balanced diet e.g. added fruit and fibre and drink plenty of fluid. Keep as mobile as possible as mobility aids the function of the gut. If you normally move your bowels on a daily basis and are now constipated please inform staff. If necessary you will be treated with laxatives. WHEN WILL I BE READY TO GO HOME? Your progress will be assessed daily by the doctors and nurses, and although length of stay in hospital depends on the individual, you should expect to be discharged home approximately 7 days after your operation. The process of planning your discharge commences on admission to the hospital. Before admission please give some thought to how you will manage after discharge. During the first few days at home you may feel 7

CHEST DRAINS After chest surgery, extra air and fluid tend to collect in the chest cavity. One or two chest tubes will be placed around the lung in the chest to help drain the fluid and air. The chest tubes are attached to drainage bottles (see picture below) PHYSIOTHERAPY While you are still recovering from your anaesthetic you can expect to have an oxygen mask over your mouth and nose. It is important that you to take deep breaths frequently and cough, this will help to expand your lungs and prevent infection. It is normal to be chesty after your surgery and it is important you work with the physiotherapist to clear your chest. The picture to the right shows an incentive spirometer. This is used to encourage you to take deep breaths. Putting the mouthpiece in your mouth you inhale/suck air into your lungs so that the balls move upwards. You should aim to move all the balls upwards and hold for 3 seconds. This should be repeated 3 times then you should rest for 1 minute. You should repeat this 3 times before attempting a supported cough every hour. 6 You can expect to see blood in the tubes, however this will clear after a couple of days. Your chest drains may be attached to suction which is a mild vacuum; this will help your lung re-expand more quickly. This does however, restrict your mobility in moving around the bed area as the drains can only be disconnected from suction if the doctor feels that you condition allows this. An x-ray of your chest will be taken to decide when the tube(s) should come out. The tubes are generally removed after a few days, however they may be removed as early as the day after your surgery. Following your operation the ward nurse will discuss with you in more detail how to look after your drains. The morning after your surgery your physiotherapist and the nursing staff will help you to sit out of bed. You will begin to walk short distances as soon as possible. The distance you walk will then be increased every day by your physiotherapist at a pace appropriate to your recovery. You may be surprised that mobilisation begins so soon after surgery but this is necessary to help your lungs return to normal function and to improve your lung function. If you use any mobilising aid such as a walking stick prior to surgery you should bring this with you into the hospital as you will require it to assist your walking after surgery. Although it is common to feel slightly breathless in the immediate post operative period, if you find that you are experiencing breathlessness, An operation to remove a lobe of the lung is called a lobectomy. A pneumonectomy is the removal of an entire lung. All types of lung surgery are performed under a general anaesthetic and usually involve staying in hospital between 7-10 days. Your doctor will discuss with you what your operation will involve and how it will affect you afterwards. If you require further information please ask questions. ARE THERE ANY ALTERNATIVES TO SURGERY? This depends on your condition. Alternatives to lung surgery for cancer include radiotherapy and chemotherapy. However, depending on your individual case these may give inferior results to surgery. Your doctor will be happy to discuss other treatments if they are applicable to you, and make the appropriate referral to an oncologist to discuss these treatments IS THERE ANYTHING I SHOULD DO BEFORE MY OPERATION? Continue to take all of your prescribed medications. If you smoke, giving up before the operation reduces the risk of post operative infection and breathing problems. The longer you can give up beforehand the better. WHAT DO I NEED TO BRING IN TO HOSPITAL? Bring a wash bag, pyjamas, towels, dressing gown and slippers. We advise that you do not bring any valuables with you to hospital. We encourage patients to send as much property home with relatives as possible. Bring a list of your medications with you, there is no need to bring the medications. WHAT WILL HAPPEN AFTER I GET ADMITTED TO HOSPITAL? Your surgeon will need you to have certain investigations before your surgery. The tests required depend on the individual. You may have these investigations done as an out patient, at the pre admission clinic or as an inpatient prior to your surgery. If you require pre-operative investigations your consultant may bring you into hospital a few days prior to your operation to have them done. Some of the tests which may be carried out are: CHEST X-RAY - this will look at the size and shape of the heart and the general condition of your lungs. ELECTROCARDIOGRAM (ECG) this shows the electrical activity of the heart and is routine for anyone undergoing a general anaesthetic. BLOOD TESTS blood samples are taken from your arm and various tests are carried out including your blood group. 3

PULMONARY FUNCTION TESTS these are breathing tests which measure how well your lungs are working. CT SCAN (CAT SCAN) this is a type of X ray that produces detailed cross sectional images from inside the body. PET SCAN from your point of view this is very like a CT scan but allows the surgeon to better judge the pattern of spead of your cancer. BRONCHOSCOPY this is a procedure carried out under a general anaesthetic. It is a test that allows the doctor to look directly down your windpipe and into some areas of your lungs. The doctor is able to view both lungs by passing a long thin tube with a camera and a light on the end of it (bronchoscope) down your throat. During the test a biopsy may be taken for further examination in the laboratory. After admission the cardiothoracic team will review all your tests to ensure that you are ready for your surgery. He/she will talk to you about your planned operation and will get you to sign a consent form for surgery. You will meet an anaesthetist before your operation; they will discuss your anaesthetic, and also post operative pain relief. A physiotherapist will visit you and review post operative breathing exercises with you. Your nurse will assist you in preparing for your surgery. WHAT HAPPENS BEFORE MY OPERATION? EATING AND DRINKING You will not be allowed to eat and drink anything for several hours prior to surgery. The nursing staff will inform you when to stop eating and drinking. It is important not to eat or drink anything after this time as it may delay your operation or cause complications with your anaesthetic. BATHING / SHAVING It will be necessary for you to have a bath or shower before your operation. The nursing staff will advise you when the best time to do this is. They will also provide you with an antiseptic skin wash to use. This will help to prevent any infection occurring in your wound. Before the operation, it may be necessary to remove hair from around the operation site. Your ward nurse will discuss this with you. STOCKINGS AND GOWN You will be given a theatre gown and a pair of elastic stocking to wear prior to going to theatre. The stockings are to help your circulation, improve blood flow and to help prevent deep vein thrombosis (blood clots in the lower leg), whilst your mobility is restricted. PRE-MEDICATION If prescribed by your anaesthetist, you will be given medication before your operation. This is given to help reduce or relieve anxiety. Following the pre-medication you must stay in bed and call for a nurse should you need anything. WHAT HAPPENS AFTER MY OPERATION? Your operation will take approximately 2 4 hours, following which you will regain consciousness in the recovery area of the theatre. There will be a nurse in attendance who will monitor your blood pressure, pulse rate and oxygen levels. It may be necessary for you to spend a period of time in the high dependency unit or intensive care unit before returning to your ward. Your family may wish to visit you on the day of your operation and during your stay. They should discuss visiting arrangements with the ward nurse or ward manager. BREATHING While you are still recovering from your anaesthetic you can expect to have an oxygen mask over your mouth and nose. It is important that you to take deep breaths frequently and cough, this will help to expand your lungs and prevent infection. Although it is common to feel slightly breathless in the immediate post operative period, if you find that you are experiencing breathlessness, you should inform the ward staff. INFUSIONS AND CATHETERS Whilst you are asleep, a drip will be placed in a vein in your arm or neck which will allow you to have any drugs or intravenous fluids required. You will also have a catheter (fine tube) in your bladder, which allows urine to drain freely. These will all be removed as soon as possible after your operation. PAIN Effective pain relief is important following surgery for your comfort and recovery. You may be given pain relief through a fine tube in your back; this is known as an epidural or alternatively via a patient controlled pain device in your arm, which will help to keep you comfortable. It is very important that you let the staff attending to you know if you are experiencing pain, they will review your pain relief as needed. YOUR HEART BEAT After the operation you may feel that your heart sometimes misses a beat or is racing. This is not uncommon after lung surgery and should not hinder your recovery. If you are aware of this, please inform your ward nurse or doctor. If this is detected during your hospital stay, you may be prescribed tablets that control your heartbeat. 4 5