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Completion pneumonectomy for lung metastases: is it justified?
D Grunenwald1, L Spaggiari, P Girard
1Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France.
Summary
Completion pneumonectomy for pulmonary metastases yields extremely poor long-term survival. Indications for iterative and extended pulmonary resections should be highly restrictive, even in young patients.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Pulmonary metastases (PM) are a significant challenge in cancer management.
- Iterative and extended pulmonary resections are sometimes employed for PM.
- Completion pneumonectomy (CP) represents a radical approach for extensive PM.
Purpose of the Study:
- To evaluate the postoperative outcomes and long-term results of patients undergoing completion pneumonectomy for pulmonary metastases.
- To assess the efficacy and safety of iterative and extended pulmonary resections leading to CP.
Main Methods:
- A retrospective review of 12 patients who underwent CP for PM between 1985 and 1995.
- Analysis of patient demographics, previous pulmonary resections, operative details, and survival data.
- Patients included sarcoma (5) and carcinoma (7) with prior resections ranging from single to multiple procedures.
Main Results:
- The 5-year survival probability was a dismal 10%, with a median survival of 6 months post-CP.
- Two perioperative deaths occurred (8.3%), and 9 out of 10 patients who survived the surgery died from metastatic disease.
- Only one patient remained alive and disease-free at 69 months.
Conclusions:
- Completion pneumonectomy for pulmonary metastases is associated with extremely poor long-term outcomes.
- Indications for iterative and extended pulmonary resections for PM should be highly restrictive.
- The findings suggest a need for even more conservative approaches to CP in managing pulmonary metastatic disease.