HONORARY SURGEON, ROYAL HOSPITAL, WOLVBRHAMPTONTHE subject of total removal of a lung is one which has had increasing prominence in the literature during the last few years. Though the operation was first attempted as long ago as 1910, no successful case was reported until 1931. Up to the present there have been reports of 34 cases in the literature and references to a further 10. Of 36 cases where the diagnosis is given, in 19 the operation was performed for a tumour of the lung, and in the remaining 17 for inflammatory conditions. Of the total of 44 cases, 24 have survived the operation, giving a case mortality of a little under 50 per cent. These results are steadily improving, and the figures for the last year or two are considerably better than this.The problems connected with this extensive operation have recently been admirably summarized in a paper by Overholt,l who gives a careful description of a series of 8 personal cases. There is no doubt that in the present limited experience of the operation no definite rules can be laid down. The present writer will, therefore, enumerate the main problems connected with this operation, particularly as performed for inflammatory conditions in the lung, and give a report on a personal case together with a table of the cases so far recorded. It was felt that such a table might throw light on some of the more important dangers of the operation, with particular reference to the fatal cases where the cause of death is stated.There are two separate groups of cases in which this operation of removal of a whole lung has been performed : firstly, bronchiectasis and multiple abscesses in the lung, and, secondly, new growths. In cases of bronchiectasis, it is necessary to ascertain by means of a bronchogram that the disease is entirely limited to one side, but in those cases in which both upper and lower lobes are involved, and which have not yielded to less severe measures, the operation certainly has a field of usefulness ; whether it will displace a thoracoplasty for such cases remains to be seen after further experience, but most thoracic surgeons seem to be agreed that the results of the latter operation in this disease are disappointing. Regarding malignant growths of the lung, the increasing use of the bronchoscope is certainly leading to earlier diagnosis, and where there is a possibility of radical extirpation of the disease by means of pneumonectomy, the attempt is certainly worth making. How permanent as regards the question of recurrence the results will be, can only be ascertained after a much longer experience, but the supervention of both local recurrence and cerebral metastases has already been recorded in cases where it had been hoped that the disease had been entirely eradicated by complete removal of the lung.The problem is somewhat different in the inflammatory cases from what it is where a new growth without subsequent inflammation exists. No definite rule can be laid down regarding the choice of a single-stage or a multiple-stage operation ;
