Indications and results of completion pneumonectomy

Abstract

Objectives: Completion pneumonectomy (CP) is widely known to be associated with a high morbidity and mortality. However, in certain instances, CP offers the only chance for a cure. The results of the following three groups were investigated: progressive or recurrent benign disease, recurrence of a malignant tumour and complication after lung resection.

Methods: Between January 1986 and April 2003, 525 patients underwent pneumonectomy, 86 of these being completion pneumonectomies (16.4%). Six patients suffered from a progression or recurrence of a benign disease, 41 patients had a recurrence of a malignant tumour (local recurrence, secondary carcinoma and recurrent metastases) and 39 patients had a complication after lung resection. Among patients with a complication, the indication for CP was either an emergency or urgent condition. Right CP was carried out in 48 cases and left CP in 38.

Results: The overall 30-day mortality was 20.2, 0% in the group with benign disease, 10% in the group with a recurrent malignant tumour and 33.3% in the group with a complication after lung resection. The 30-day mortality of CP was significantly higher (P = 0.014) on the right side (29.8%) than on the left side (7.7%). Differentiation between emergency and urgent indications resulted in 30-day mortalities as follows: 54 and 23%, respectively. This difference is significant (P = 0.002). The 30-day mortality for patients with anastomotic or stump insufficiency was 41% (P = 0.002). Five-year survival of all patients was 28% and in the group of patients with a complication after lung resection 32%.

Conclusions: Lethality of CP remains high, especially after CP for a complication performed in an emergency condition. Possible risk factors are right side of operation, CP performed in an emergency condition and CP for anastomotic or stump insufficiency, either or not involving sepsis. However, considering the long-term survival, CP is certainly justified.