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[Completion Pneumonectomy and Perioperative Managements].

Yosuke Matsuura1, Sakae Okumura

  • 1Department of Thoracic Surgical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
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Completion pneumonectomy (CP), a complex thoracic surgery, involves removing remaining lung tissue after initial resection. Careful patient selection and surgical expertise are crucial due to high risks and potential benefits for lung cancer recurrence.

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Area of Science:

  • General Thoracic Surgery
  • Surgical Oncology

Background:

  • Completion pneumonectomy (CP) involves complete removal of remaining lung tissue after a prior ipsilateral partial resection.
  • CP is a highly invasive procedure associated with increased mortality and morbidity compared to standard pneumonectomy.
  • Dense adhesions from prior surgery or infection often complicate CP, necessitating specific surgical techniques.

Purpose of the Study:

  • To review the surgical techniques, challenges, and patient selection criteria for completion pneumonectomy.
  • To highlight the importance of preoperative assessment and postoperative management in improving outcomes.
  • To evaluate the role of CP in managing postoperative lung cancer recurrence or new primary tumors.

Main Methods:

  • Review of existing literature on completion pneumonectomy procedures.
  • Analysis of factors contributing to operative difficulty, such as adhesions.
  • Discussion of recommended surgical approaches, including intra-pericardial control of great vessels.
  • Emphasis on patient selection based on preoperative cardiopulmonary function and oncological benefit versus surgical risk.

Main Results:

  • CP is technically demanding, with higher complication rates due to invasiveness and adhesions.
  • Intra-pericardial control of pulmonary artery and veins is advised to prevent injury.
  • Preoperative pulmonary and cardiac functions are often compromised from previous interventions.
  • Careful patient selection and surgical expertise are paramount for successful outcomes.

Conclusions:

  • Completion pneumonectomy should be reserved for carefully selected patients by experienced thoracic surgeons.
  • Meticulous preoperative evaluation, precise surgical technique, and diligent postoperative care are essential.
  • CP can be a viable option for selected cases of lung cancer recurrence or new primaries when oncological gains outweigh surgical risks.