[Completion Pneumonectomy]

A completion pneumonectomy(CP) is a procedure used to remove remaining lung tissue following an operation previously performed for anatomical resection. During the initial operation, manipulation of the pulmonary artery and vein during incision of the mediastinal pleura can influence dissection of the hilum vessels and bronchus in the mediastinum, causing severe adhesion and tissue fragility, thus making a CP difficult to perform. As compared to a standard pneumonectomy, it is considered to be a more challenging technical procedure, and associated with increased operative mortality and morbidity. Intrapericardial manipulation of pulmonary vessels by early opening of the pericardium is safe and effective in cases when difficulty with tearing of the hilar pulmonary vessels is encountered. CP may be a reasonable option for lung cancer cases, including postoperative lung cancer recurrence, second primary tumors, or metastasis from tumors in other organs occurring after a previous lobectomy done for treatment of malignant or benign disease. However, it should only be performed in carefully selected cases, in which the potential oncological benefits outweigh the surgical risk. In this paper, indications for CP and the procedures employed, as well as perioperative management are discussed.