Is it safe and worthwhile to perform pulmonary resection after contralateral pneumonectomy?: Table 1:

Abstract

A best evidence topic was written according to a structured protocol. The question addressed was whether pulmonary resection is safe and worthwhile in patients who have undergone previous pneumonectomy. A total of 141 studies were identified using the reported search, of which 8 represented the best evidence to answer the clinical question. Studies on multiple lung cancers with patients undergoing subsequent pulmonary resection after previous pneumonectomy, without outcome data specifically for this group of patients and case reports, were not included in this analysis. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. All studies were retrospective. In total, 102 patients underwent pulmonary resection after contralateral pneumonectomy, of which 96 had sublobar resections and 6 had lobectomies. Postoperative complications, reported in four of the eight studies, ranged from 21 to 44% (mean from four studies 36.8%). Four of the eight studies reported no mortality after pulmonary resection following pneumonectomy, whereas the other four reported mortality rates from 6.7 to 43%. For patients undergoing sublobar resections, the postoperative mortality was 6.2% (6/96), while for those submitted to lobectomy, mortality was 33.3% (2/6). Five-year survival rates ranged from 14% for metastatic disease to 50% for metachronous lung cancer. Due to the infrequent situation of a patient being considered for a pulmonary resection after contralateral pneumonectomy, this analysis was based on a limited number of patients from eight reports. Nevertheless, analysis of the data suggests that pulmonary resection for metastatic or metachronous disease can be performed with acceptable morbidity and low mortality in appropriately selected patients who have previously undergone a pneumonectomy. Sublobar resection is the treatment of choice whenever possible, for which long-term results are rewarding especially for patients with metachronous lung cancer.

Thoracoscopic partial lung resection following pneumonectomy: a report of three cases

“…When patients undergo unilateral pneumonectomy and subsequently develop a contralateral pulmonary tumor, we should take cognizance of the patient’s pulmonary function, whether or not the tumor is metachronal lung cancer, and whether or not it is a metastatic lesion when determining the operative method. Toufektzian et al [3] stated that pulmonary resection for metastatic or metachronous diseases can be performed with acceptable morbidity and low mortality in appropriately selected patients who have previously undergone pneumonectomy. Donington et al [4] stated that limited resections should be the method of choice after a pneumonectomy.…”

Thoracoscopic wedge resection in single-lung patients

“…A recent literature review shows that pulmonary resection for metastatic or metachronous disease can be performed with acceptable morbidity (ranging from 6.2% to 28.6%) and low operative in appropriately selected patients who have previously undergone a pneumonectomy. Sub-lobar resection is the treatment of choice whenever possible, for which longterm results are rewarding especially for patients with metachronous lung cancer (1).…”

“…Surgery is not justified in case of centrolobar lesion that could result in a lobectomy or a deep wedge resection with the need of thoracotomic approach and with insufficient residual pulmonary function. Thus, broad pulmonary resections such as lobectomy, segmentectomy or multiple atypical resections have been associated with worse results in pneumonectomised patients (1,7,12). Furthermore, perihilar lesions can be easily biopsied during bronchoscopy.…”

“…Patients who have undergone pneumonectomy for lung cancer may develop new or metastatic cancer in the contralateral lung. Surgical resection for suspicious lung cancer on a single-lung patient after pneumonectomy for a previous primary lung neoplasm is an uncommon operation; slightly more than 100 cases have been reported in the literature (1). This challenging procedure is rarely indicated because of patients' inadequate respiratory reserve or cancer spreading (synchronous distant metastasis).…”

“…This challenging procedure is rarely indicated because of patients' inadequate respiratory reserve or cancer spreading (synchronous distant metastasis). However, analysis of the published data suggests that pulmonary resection for metastatic or metachronous disease can be performed with acceptable morbidity and low mortality in appropriately selected patients (1). Recently, the thoracoscopic approach has become a standard procedure in the field of lung resection.…”