[Clinical analysis of completion pneumonectomy for pulmonary disease]

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. Now to explore the indications, prevention and management of complications as well as late outcomes of CP.

During a period of 21 years from January 1985 to August 2006, 24 patients received CP, representing 2.3% of 1026 patients who had undergone pneumonectomy in the same period. There were 17 right and 7 left CPs done in 20 male and 4 female patients with an average age of 58 years (range from 42 to 67 years). Lung malignancy accounted for 22 of these cases in which the indication included local recurrence in 18, second primary tumors in 2 and primary malignancies that developed after right upper lobectomies for pulmonary tuberculoma and pulmonary cyst respectively in 2 cases. Benign disease was progression or recurrence of bronchiectasis in 2 cases. Before CP, 17 patients had had a lobectomy, 5 a bilobectomy, 1 sleeve lobectomy and 1 wedge resection. There were 16 of 20 lung cancer patients receiving postoperative chemotherapy and 3 with positive residues having radiotherapy. The mean interval between the two procedures was 65 months for the whole group (5.5-360) and 32 months for lung cancer patients (5.5-120). They all underwent CP, included sleeve CP in 1 patient.

For all patients, the previous thoracotomy incision was reopened and maneuvers such as rib resection, intrapericardial blood vessel ligation, division of the bronchus first, local application of glues and hemostatic agents, and bronchial reinforcement were routinely used. Intrapericardial route was used in 10 patients (41.7%). Two patients had right pulmonary artery injured. The operation lasted 4-7 hours, with blood loss of 300 to 3000 ml. Overall respectability, morbidity and hospital mortality were 95.8%, 29.2% and 4.2%. No intraoperative deaths occurred. There was 1 early postoperative death after 40 days from adult respiratory distress syndrome. There was no occurrence of bronchopleural fistula, and the 25% associated morbidity rate was a result of bleeding necessitating reexploration in 1 case, chronic empyema in 1 case, arrhythmia in 1 case, anemia in 1 case and fever of unknown reason in 2 cases. Actuarial 1-, 3-, 5-year survival rates from the time of completion pneumonectomy for patients with lung cancer were 77.3%, 50.0% and 29.4%. And 1-, 3-, 5-year survival rates for patients with recurrent lung cancer were 72.2%, 47.1% and 29.4%.

CP can be performed with an acceptable operative mortality and morbidity rate in selected patients. For patients with local recurrence, first and second primary bronchogenic carcinoma as well as benign pulmonary disease, treatment should be surgical when a less invasive procedure is not available and the patients are in good health. In addition, patients undergoing CP have a reasonable prospect for long-term survival.