VV-ECMO during subsequent segmentectomy after right pneumonectomy

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Oncology

Background:

• Subsequent pulmonary resections after pneumonectomy are uncommon, particularly in elderly patients with compromised lung function.
• Metachronous multiple lung cancers present unique challenges for surgical management, especially following prior extensive lung resections.

Observation:

• An 82-year-old woman with a history of right upper lobe adenocarcinoma and prior completion pneumonectomy presented with new lung lesions.
• Despite poor pulmonary function, her performance and cardiac status were adequate for consideration of further surgical intervention.

Findings:

• A segmentectomy of S6 + S10a was successfully performed using venovenous extracorporeal membrane oxygenation (VV-ECMO) to ensure surgical safety.
• The patient experienced no complications at 30 months post-surgery and showed no evidence of cancer recurrence on imaging.

Implications:

• Venovenous extracorporeal membrane oxygenation (VV-ECMO) can be a valuable tool to facilitate complex pulmonary resections in high-risk elderly patients.
• This case demonstrates the feasibility of achieving favorable outcomes in carefully selected patients undergoing repeat lung surgery after pneumonectomy.