Completion pneumonectomy: current indications, complications, and results.

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Cardiothoracic Surgery

Background:

• Completion pneumonectomy is a complex procedure often associated with high morbidity and mortality.
• Existing data on outcomes, particularly for benign disease indications, are limited.
• Understanding postoperative results and long-term survival is crucial for patient management.

Purpose of the Study:

• To evaluate the postoperative outcomes and long-term results of completion pneumonectomy.
• To assess the safety and efficacy of this procedure across various indications, including benign and malignant diseases.
• To identify factors influencing outcomes and complications.

Main Methods:

• Retrospective review of 66 consecutive completion pneumonectomy cases between January 1990 and December 1998.
• Patients were categorized by indication: benign disease (17) and malignant disease (49).
• Analysis included postoperative mortality, complication rates, and actuarial 5-year survival.

Main Results:

• The postoperative mortality rate was 7.6%, with no intraoperative deaths.
• Overall complication rate was 53%, with no significant difference between benign (71%) and malignant (47%) indications.
• Actuarial 5-year survival was 57% for all patients, with similar rates for benign (65%) and malignant (54%) indications.

Conclusions:

• Completion pneumonectomy can be performed with acceptable mortality and morbidity, even for benign conditions.
• Effective management strategies exist for complications like bronchopleural fistula and empyema.
• Preoperative infection can be managed with bronchial stump covering and adequate drainage, leading to successful outcomes.