Early and long-term results after completion pneumonectomy

From January 1, 1978 to December 31, 1992, 37 patients underwent a completion pneumonectomy after a previous lobectomy (36 men and 1 woman; mean age, 60 years; range, 41 to 77 years). These account for 4.8% of 758 pneumonectomies. The purpose of the present study was to evaluate the operative results of completion pneumonectomy and long-term survival in patients with bronchogenic cancer. The initial lung resection had been performed for primary bronchogenic cancer in 23, metastatic thyroid adenocarcinoma in 1, and benign diseases in 13 (tuberculosis in 11, aspergilloma in 1, and bronchiectasis in 1). Completion pneumonectomy was required for bronchogenic cancer in 32 (15 stage I, 6 stage II, 11 stage III). One patient had relapsing metastatic thyroid carcinoma, 2 had bronchiectasis, and 2 had a venous infarction after lobectomy. Four patients (10.8%) died perioperatively of the following causes: I fatal intraoperative bleeding, 1 fatal postoperative bleeding, 1 pneumonia, and 1 malignant hypercalcemia. Median operative blood loss was 1,000 mL, and 19 patients experienced bleeding exceeding 1,000 ml. (51%). Six patients had intraoperative vascular injury. Nonfatal surgical complications occurred in 9 patients (24%%), including 5 clotted hemothoraces, 3 empyemas, and 1 bronchopleural fistula. Four patients had medical complications (2 pulmonary edemas, 1 sinus tachycardia, and 1 unexplained fever). Twenty-three had an uneventful straightfoward recovery (62%). The 32 patients with bronchogenic cancer were followed up until date of death or July 1, 1993. Overall 5-year survival was 44.5% (59.7% for stage I, 41.6% for stage II, and 21.2% for stage III). We conclude that there is an increased operative risk after completion pneumonectomy; however, this risk is acceptable with respect to long-term survival.