Indications, risks, and results of completion pneumonectomy

Abstract

Completion pneumonectomy refers to an operation intended to remove what is left of a lung partially resected during a previous operation. The procedure is seldom indicated and, according to current medical literature, it carries a higher risk of operative mortality and morbidity than does standard pneumonectomy, especially when done for benign disease. Over the past 20 years, 60 consecutive patients aged 17 to 70 years and having a diagnosis of recurrent lung cancer (n = 28), new primary lung cancer (n = 13), or benign pleuropulmonary disease (n = 19) underwent completion pneumonectomy. The mean interval between the first operation and completion pneumonectomy was 30 months for patients with carcinoma and 215 months for patients with benign disease. For all patients, the previous thoracotomy incision was reopened and maneuvers such as rib resection, intrapericardial blood vessel ligation, division of the bronchus first, local application of glues and hemostatic agents, and bronchial reinforcement were routinely used. Six patients died during (n = 2) or after (n = 4) the operation, for an overall operative mortality of 10%. The rate was higher for patients with carcinoma (11.6%) than for patients with benign disease (5.9%). Actuarial 5-year survivals from the time of completion pneumonectomy were 48% for the entire population, 33% for patients with cancer, and 88% for patients with benign disease. These results suggest that completion pneumonectomy can be done with an operative risk similar to the one reported for standard pneumonectomy (6% to 10%). In addition, patients undergoing completion pneumonectomy have a reasonable prospect for long-term survival.