[Pulmonary metastasectomy after pneumonectomy]

INTRODUCTION, OBJECTIVES: Authors of two thoracic surgical departments from the above named hospitals discuss their practices of pulmonary metastasectomy after pneumonectomy for malignant disease.

Six patients were operated after pneumonectomy for metastatic spread in the residual lung. The average age of the three male and three female patients was 52.5 years. The applied preoperative diagnostical methods were the following: chest-x-ray, CT scan, MRI, PET-CT scan, perfusion lung scintigraphy, bronchological examinations, functional respiratory tests, ECG, cardiac echo, arterial blood gases (ABGs) and other laboratory analyses. Patient selection for operation was based on strict oncological and cardiorespiratory criteria. Finally, the authors describe the applied operative technique; atypical mechanical resection with stapler.

Mean length of postoperative intensive care was between 3 to 7 days, while that of hospitalization altogether was 13 to 18 days (average 15.2 days). Ventilation needed for one patient for 5 days approximately. Two of the six patients' survival was 18 and 25 months after pulmonary metastasectomy. Four patients are still alive, their average postoperative survival is 33.5 months. They are followed up regularly and their quality of life is satisfactory.

The key factors that determine the successful outcome of metastasectomies are careful and personalized evaluation of the patients, their condition and fitness for thoracotomy, stabile cardiopulmonary functions and the capacity of the residual lung. Multidisciplinary teamwork involving anaesthetists and intensive care specialists along with surgeons using the quick atypical resection technique are the key elements to improved survival of these patients.