Anterior thoracotomy for right pneumonectomy and carinal reconstruction in lung cancer

Between September 1984 and December 1990, seven patients underwent right pneumonectomy and carinal reconstruction. All patients but one had squamous-cell lung cancer. Anterior thoracotomy through the 4th space was the surgical access in all cases. The mean time needed to perform the operation was 190 min and the mean blood infusion 340 ml. There were no intraoperative deaths. Of three deaths, only one was attributable to cancer, while two occurred after 84 and 94 days, respectively, as a result of cardiorespiratory failure. The median disease-free interval was 12 months, but the median survival had not been reached (51%) after a median follow-up of 47 months. Calculation of predicted and observed FEV1 showed that a mean decrease of 286 ml (range 145-439) occurred in the observed FEV1. More attention to pulmonary function is therefore required, and anterior thoracotomy is recommended as the surgical approach.