Completion pneumonectomy: outcomes for benign and malignant indications.

Area of Science:

• Thoracic Surgery
• Surgical Outcomes
• Pulmonary Medicine

Background:

• Completion pneumonectomy (CP) is recognized as a high-risk surgical procedure.
• Previous studies highlight the significant risks associated with CP.
• This study aimed to identify factors influencing CP outcomes under a selective approach.

Purpose of the Study:

• To evaluate the factors affecting outcomes of completion pneumonectomy (CP).
• To analyze the outcomes of CP in comparison to primary pneumonectomy (PP).
• To assess the impact of disease type (benign vs. malignant) on CP outcomes.

Main Methods:

• Analysis of a prospective institutional database of patients undergoing pneumonectomy.
• Comparison of patients who underwent CP versus those who underwent primary pneumonectomy (PP).
• Data abstraction included patient demographics, diagnosis, perioperative complications, and survival.

Main Results:

• Out of 211 pneumonectomies, 35 (17%) were CPs, with 29% for benign and 71% for cancer.
• Major perioperative morbidity occurred in 60% of CP patients, with an 11% perioperative death rate.
• CP for benign disease had a 100% major complication rate versus 44% for malignancy (p=0.002). Bronchopleural fistula was more common with shorter intervals post-primary operation (p=0.018).
• Perioperative mortality for PP (5.7%) was similar to CP (11%). CP patients were more likely to have benign disease (29% vs 8%, p=0.001).

Conclusions:

• Completion pneumonectomy (CP) remains a high-morbidity operation, particularly for benign indications, even with a selective strategy.
• Rigorous preoperative optimization and careful surgical technique are essential for managing CP.
• Identifying and addressing contraindications preoperatively is critical for patient safety.