Extracorporeal Membrane Oxygenation Assisted Segmentectomy for Metachronous Lung Cancer After Pneumonectomy

Abstract

Advances in extracorporeal membrane oxygenation have enabled the facilitation of surgical intervention in patients who may otherwise be considered inoperable using conventional ventilation-for example, the resection of an early stage metachronous lung cancer in a patient who has previously undergone a pneumonectomy for a prior lung cancer. We present one such case: a 52-year-old man who underwent right lower lobe segmentectomy for a second primary lung cancer, 3 years after left pneumonectomy, using extracorporeal membrane oxygenation. To our knowledge, there are no published case reports describing the use of extracorporeal membrane oxygenation in resection of metachronous lung cancer after pneumonectomy.

Short veno-venous extracorporeal membrane oxygenation assisted segmentectomy for second primary lung tumor in a patient with insufficient respiratory function for one lung ventilation

“…Therefore, in selected cardiorespiratory fit patients a surgical therapy should be carried out [ 5 ]. Until recently, some of these patients were considered inoperable due to infeasibility of one-lung ventilation which would be associated with a great perioperative risk [ [2] , [3] , [4] , [5] ]. Ipsilateral lung's endotracheal ventilation through a small catheter with tidal volumes can have a limited duration of approximately 30 minutes and can lead to severe respiratory acidosis while surgery has to be carried out on a ventilated lung [ 2 ].…”

“…The possible complications of the vv-ECMO in its general thoracic surgical use are approximately the same with the ones of the general use of vv-ECMO. The major complication of the device is bleeding because of the heparin use [ [1] , [2] , [3] ]. However, the risk of a perioperative hemorrhage is lower than using conventional cardiopulmonary bypass [ [1] , [2] , [3] ].…”

“…Extensive lung resection for second primary lung cancer with poor contralateral lung function is rarely performed and is a challenging task for the treating disciplines [ [1] , [2] , [3] , [4] ]. Until recently, respective patients were rendered inoperable by conventional one-lung ventilation.…”

“…Until recently, respective patients were rendered inoperable by conventional one-lung ventilation. The extracorporeal membrane oxygenation (ECMO) allows a safe performance of this rare operation [ [1] , [2] , [3] ]. We present a case of veno-venous (vv)-ECMO assisted segmentectomy for second primary lung cancer in which one-lung ventilation was not feasible (see Fig.…”

Extrakorporale Membranoxygenierung in der Thoraxchirurgie: die Sicht des Anästhesisten

“…Auch bei komplexen onkologischen Lungenresektionen oder Eingriffen am Ösophagus beim bereits auf der Gegenseite pneumonektomierten oder lungentransplantierten Patienten stellt eine intraoperative vvECMO eine sichere Option dar, den Gasaustausch während des Eingriffs zu unterstützen [13,[15][16][17][18].…”