Is Pneumonectomy Obsolete? Our Experience in the Current Clinical Landscape

Although the role of pneumonectomy has declined with advances in lung-sparing techniques and multimodal therapies, it remains essential in select cases. High morbidity and mortality remain concerns, but careful patient selection and perioperative optimization have improved outcomes. This study evaluates the relevance of pneumonectomy in the current clinical setting. A retrospective analysis was conducted of all pneumonectomy cases at a tertiary cancer centre in India from January 2015 to March 2024. Demographics, clinic-pathological characteristics, postoperative outcomes, and survival data were analyzed. Among 412 patients who underwent major lung resections, 19 (4.6%) required pneumonectomy. The mean age was 51.9 years (range 27-76); 74% were male, and 52% had a history of smoking. Left-sided pneumonectomy was more frequent (68.4%). Lung cancer was the most common indication (78.9%), followed by carcinoid tumours and inflammatory conditions (10.5% each). Postoperative complications occurred in five patients (26.3%). Two patients experienced early complications-atrial fibrillation and subcutaneous emphysema-while three developed bronchopleural or esophagopleural fistula in case of pleural windows, all requiring surgery. In-hospital mortality was 10.5% (two patients). The median follow-up was 13 months. Among cancer patients, median overall survival was longer for carcinoma than sarcoma (29 vs. 2 months), and for early- vs. locally advanced stage disease, though not statistically significant. The decline in pneumonectomy rates underscores advances in lung-sparing surgical techniques and alternative treatment modalities. Nevertheless, in the Indian context, where locally advanced lung cancer and extensive inflammatory lung damage are prevalent, pneumonectomy retains a significant role. With meticulous perioperative management, acceptable postoperative outcomes can still be consistently achieved.