Completion Pneumonectomy: Outcomes for Benign and Malignant Indications

Abstract

Background Past series have identified completion pneumonectomy (CP) as a high-risk operation. We evaluated factors affecting outcomes of CP with a selective approach to offering this operation. Methods We analyzed a prospective institutional database and abstracted information on patients undergoing pneumonectomy. Patients undergoing CP were compared to those undergoing primary pneumonectomy (PP). Results Between 1/2000 and 2/2011, 211 patients underwent pneumonectomy, of which 35 (17%) were CPs. Ten of 35 (29%) CPs were for benign disease and 25/35 (71%) for cancer. Major perioperative morbidity was seen in 21/35 (60%) with 4 (11%) perioperative deaths. In univariate analysis, postoperative bronchopleural fistula (p=0.05) and benign diagnosis (p=0.07) tended to be associated with perioperative mortality. All 10 patients undergoing CP for benign disease developed a major complication compared to 11/25 (44%) with malignancy, p=0.002. A bronchopleural fistula (4/35, 11%) was more likely to occur in patients undergoing CP shortly after the primary operation (interval between lobectomy and CP; 0.28 vs. 4.5 years; p=0.018) with a trend towards a benign indication for operation (p=0.07). Median survival after CP for benign and malignant indications was 24.3 months and 36.5 months respectively. Comparing CP patients to those undergoing PP (n=176), CP patients were more likely to undergo surgery for benign disease (10/35, 29% vs. 14/176, 8%, p=0.001). Perioperative mortality for PP was 10/176 (5.7%), and was statistically similar to CP (11%). Conclusions Despite a selective approach, CP remains a morbid operation particularly for benign indications. Rigorous preoperative optimization, ruling out contraindications to surgery and attention to technical detail are recommended.

Development and Validation of a Risk Score for Predicting Death after Pneumonectomy

“…Whether preoperative chemotherapy or radiotherapy increases operative mortality also remains unclear, as studies have found conflicting results [ 18 , 19 ]. Completion pneumonectomy has also been reported as a predictive risk factor for postoperative death [ 10 ]; however, other authors were not able to confirm these findings [ 20 ].…”

Completion pneumonectomy: Indications and outcomes in non-small cell lung cancer

“…Median survival was significantly better in CP patients who had not received neoadjuvant therapy (34.6 months vs. 11.9 months, p= 0.003). Puri et al [33] reported this as 24 months for benign CP and 36 months for malignant CP. Parallel to our study, Tabutin et al [18] stated that survival was significantly better particularly in young patients.…”

Self-inflicted oral penetration injury: An intravenous drip pole advanced from the mouth to the retroperitoneum

“…To secure our patient’s airway, a 7.0-mm spiral tube was inserted via the nasal route, and tracheostomy was performed for insertion of the DLT before exploration of the lung. Several researchers have previously reported that completion pneumonectomy has a 20–23% perioperative mortality [7] , [8] , and patients undergoing completion pneumonectomy due to benign conditions had a higher comorbidity and mortality than those with malignancy [9] . Fortunately, pneumonectomy was avoided in our patient, but it is important to consider this strategy when the patient has life threatening hemodynamic and respiratory problems.…”