Surgical Results of Completion Pneumonectomy

Abstract

Purpose: We report our experience with completion pneumonectomy (CP). Methods: We report on operative procedure and morbidity, mortality, and survival rates. Results: CP was performed for malignancy in 12 patients and postoperative complications after the first operation in 4 patients. Intrapericardial dissection of vessels was performed in 14 patients (87.5%). Partial vertebrectomy from the second to the fifth vertebrae was performed in 1 patient. Carinal resection was performed in 2 patients. Morbidity including bronchopleural fistula, pulmonary insufficiency, pyothorax, and pulmonary infarction developed in 6 of the 16 patients (37.5%). Mortality rate was 18.8%. The actuarial 1-, 3-, and 5-year overall survival after CP for all malignancy was 80.8%, 49.0%, and 49.0% respectively. Conclusions: The morbidity and mortality rates are high in CP. Combined resection, especially carinal resection, appears to be contraindicated in CP. CP is one of the treatments of choice, even for malignancy, if complete resection is possible because of the good long-term survival.

THORACIC SURGERY Completion pneumonectomy and chemoradiotherapy as treatment options in local recurrence of non-small-cell lung cancer

“…Although the rate of complications in the completion pneumonectomy group was high (80.9%), it did not influence postoperative mortality. The difference between the complication rate observed in this study and that reported by other authors (30-62%) may stem from the fact that the analysis of the cited authors included only selected, mostly severe complications [ 11 – 15 ]. The present study considered all observed complications, including postoperative anemia requiring the transfusion of blood (23.8%) or arterial pressure drops requiring catecholamine therapy (33.3%).…”

“…Although it is not a randomized prospective study, but only a retrospective analysis, it may still shed light on the efficacy and safety of each of the analyzed treatment methods. The number of surgically treated patients in the study group is low ( n = 21), but similar rates of completion pneumonectomy are reported by authors from other centers, where the number of analyzed cases rarely exceeds 50 [ 7 , 10 , 11 ]. They point to the fact that in most patients with recurrent lung cancer, there are contraindications for repeat surgery (recurrence location precluding radical procedures, mediastinal lymph node involvement, high operative risk associated with concomitant disorders, results of functional tests disqualifying the patient from pneumonectomy).…”

“…In view of this, can completion pneumonectomy still occupy a prominent role in the treatment of local lung cancer recurrence, considering that it is characterized by higher rates of mortality and serious complications in comparison with standard lung excision procedures? Some authors question its role, pointing firstly to its high rates of perioperative mortality reaching 21% [ 1 , 11 , 12 ]. Even leading centers such as the Mayo Clinic report the rates of complications after these procedures to exceed 62% [ 12 ].…”

“…Even leading centers such as the Mayo Clinic report the rates of complications after these procedures to exceed 62% [ 12 ]. The technical challenge and the extent of the operative trauma can be attested by the relatively large intraoperative blood loss ranging from 700 to 2400 ml in various publications and the mean hospitalization time reported by most studies to exceed 16 days [ 11 , 13 ]. Terzi underscores that most perioperative deaths are caused by intra- or postoperative bleeding [ 14 ].…”

Completion Pneumonectomy: Outcomes for Benign and Malignant Indications

“…(1, 2, 13) Despite this knowledge, bronchial stump reinforcement with a pedicled flap or coverage with adjacent tissue is not universally employed. (1, 4, 13-15) For our series, a relatively uniform technique was employed. Five of the 6 participating surgeons have been trained at our institution and the 6 th surgeon (GAP) has been the mentor at our program for over 20 years.…”