Pneumonectomy in the Indian scenario—a review of current indications and results

Abstract

Pneumonectomy is an important procedure in the armamentarium of the thoracic surgeon dealing with both neoplastic and non-neoplastic diseases of the lung especially in a developing country like India where the sequelae of tuberculosis are still rampant and the incidence of lung cancer is on the rise. The indications for pneumonectomy are varied. The operative techniques are standardized. Assessment of risk-benefit ratio is important as pneumonectomy carries considerable morbidity. We present our experience with 74 cases of pneumonectomy performed for varied etiologies, the outcomes of which are retrospectively analyzed in this study. We retrospectively reviewed our institutional database for patients who underwent a pneumonectomy from January 2009 to April 2015. Demography, patient profile, indications for surgery, details of operative technique, development of perioperative complications, and mortality were analyzed. Seventy-four patients underwent pneumonectomy, with a male to female ratio of 2:1. The age range was 6 to 72 years out of which six were children (8.1 %). Post-tuberculosis-destroyed lung was the predominant indication (43.24 %). Nineteen (25.67 %) underwent pneumonectomy for various tumors. Completion pneumonectomy was done in four (5.40 %). Left pneumonectomy was performed in 48 patients (64.86 %). The operative time ranged between 110 and 385 min. The mean post-operative stay was 4 days. Two patients (2.70 %) required emergency cardiopulmonary bypass for torrential hemorrhage during hilar dissection. Post-operative complications encountered were reactionary hemorrhage (1), empyema (2), bronchopleural fistula (1), and chylothorax (1). There was one early post-operative death due to fulminant respiratory failure. Early mortality rate was 1.35 %. The outcomes following pneumonectomy are favorable when careful attention to patient selection, preoperative patient optimization, meticulous surgical technique, and post-operative principles are followed. Pneumonectomy in post-pulmonary tuberculosis-destroyed lungs did not carry extra morbidity or mortality. Pneumonectomy in malignant lung/bronchial diseases is safe. Pneumonectomy in children was remarkably uncomplicated. Completion pneumonectomy can be done with an acceptable morbidity in selected patients. Use of cardiopulmonary bypass when encountered with torrential intraoperative hemorrhage is an acceptable strategy. Outcomes of hand-sewn bronchial closure technique are comparable to stapling devices and cost effective.