Completion pneumonectomy for lung metastases: is it justified? (original) (raw)
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European Journal of Cardio-Thoracic Surgery, 2008
Objective: Pulmonary resections after pneumonectomy due to metastases or metachronous non-small cell lung cancer (NSCLC) are rare because of the high potential risk of the second procedure and uncertain long-term results. On the basis of our series (largest in Europe) we tried to assess the long-term survival of patients treated in stage IV NSCLC. Methods: Retrospective analysis was carried out on 18 patients treated at our department by pneumonectomy followed by additional resection in the years 1981-2002 (15 males and 3 females, 44-69 years, mean 57). Eleven pneumonectomies were performed on the right side and seven on the left. Twelve squamous cell carcinomas and six adenocarcinomas were diagnosed. All patients were staged postoperatively as IIB-IIIA (four were N2). Their WHO status ranged between 0 and 1. The second surgical procedure (16 wedge resections, 2 chest wall resections) was performed 4-106 months later (mean 26). The patients staged N2 were radiated postoperatively. Results: There were no early postoperative deaths. The morbidity rate after second surgery was comparable to that observed after ordinary wedge resection. Histology of the lesions removed during the second operation was the same as after pneumonectomy in all patients. The pulmonary function tests (PFT) results worsened significantly but still reached 56-63% of the predicted values. Sixteen resected tumors of the remaining lung were staged T1 (<3 cm), 2 -T3 (<3 cm but infiltration of the parietal pleura on an area of 2-4 cm 2 ). Three patients revealed N2 disease (they were all N0 after pneumonectomy). All patients were considered M1 after second surgery. WHO status after the second procedure remained the same in 8 patients (44%) and worsened in 10 patients (56%). The survival rates were as follows: 11 patients survived 2 years (61%) while 8 patients survived 5 years (44%). The majority of patients died due to lung cancer (70%) but all the rest (30%) due to circulatory or respiratory insufficiency. There was a significant difference ( p < 0.05) in 5-year survival for N0-N1 vs N2 status (63% vs 14% -1 patient) and also regarding the time interval between surgeries: less than 12 months vs more than 12 months (0% vs 63%). Conclusions: Pulmonary resections performed after pneumonectomy due to NSCLC are rare procedures but with an acceptable perioperative risk. The second procedure should be limited to wedge resection. The prognosis is poor for patients with N2 status and for those treated by second surgery earlier than 12 months after the first procedure. #
Pulmonary Resection for Metachronous Lung Cancer Following Contralateral Pneumonectomy
Open Journal of Thoracic Surgery, 2013
Patients who undergo pneumonectomy for lung cancer are at risk of recurrent disease and metachronous tumours in the remaining lung. Establishing a diagnosis can be difficult as biopsy may induce a pneumothorax, whilst resection is limited by remaining lung function. However, pneumonectomy should not be a contraindication to further lung resection. We report two cases of lung cancer resection in the residual lung 6 and 11 years following pneumonectomy respectively. A limited resection can be safely performed for a new pulmonary parenchymal lesion on a background of a previous pneumonectomy.
Completion pneumonectomy for non-small cell lung cancer: experience with 59 cases
European Journal of Cardio-Thoracic Surgery, 2002
Objective: The objective of this study was to assess the results of completion pneumonectomy performed for non-small cell lung cancer, classified as second primary or recurrence/metastasis. Methods: From 1982 to 2000, 59 patients underwent completion pneumonectomy for lung cancer, classified second primary or recurrence/metastasis according to a modified form of Martini's criteria, after a mean interval from first resection of 60 months for second primary lung cancers and 19 months for recurrences/metastases. Results: Operative mortality was 3.4% and complications occurred in 30% of patients. Five-year survival rate for completely resected patients was 25% (median 20 months). No significant difference in long-term survival was detected between second primary and recurrent tumors; survival was not adversely affected by a resection interval of less than 2 years or less than 12 months. Conclusions: Completion pneumonectomy for non-small cell lung cancer is a safe surgical procedure in experienced hands; long-term survival is acceptable and the best results are obtained for stage I lung cancer. Distinction between second primary lung cancer and recurrence failed to demonstrate a prognostic value. q
Extended pneumonectomy for non–small cell lung cancer: Morbidity, mortality, and long-term results
2007
Extended pneumonectomy for non small cell lung cancer: Morbidity, mortality, Objective: Pneumonectomy is not always sufficient for the radical resection of cancer. In the present study, pneumonectomy may be associated with an extended resection of mediastinal or parietal structures. The postoperative risk and the oncologic benefits of such an extended procedure have not been sufficiently demonstrated.
Surgical Treatment in Second Lung Cancer after Pneumonectomy
2019
Metachronous lung cancer is a well-known entity in patients having undergone successful lung resection. Anatomical resection with removal of regional lymph nodes is the recommended surgical procedure of metachronous lung cancer but sublober non-anatomic resections should be considered for patients who have inadequate pulmonary capacity. Although pulmonary resection for a second lung cancer after pneumonectomy is generally considered to be at prohibitive risk it is feasible and worldwide procedure especially in highly selected patients. We present the case of patient who undergone right pulmonary wedge resection for metachronous lung cancer after left pneumonectomy.
A review of 250 ten-year survivors after pneumonectomy for non-small-cell lung cancer
European Journal of Cardio-Thoracic Surgery, 2014
OBJECTIVES: During the last decades, pneumonectomy has been increasingly seen as a risky procedure, first reserved for tumours not amenable to lobectomy, and now discouraged even in advanced stages of non-small-cell lung cancer (NSCLC). Our purpose was to assess the long-term survival following pneumonectomy for NSCLC and its prognostic factors.
Pulmonary Metastatectomy and Survival Rate of Patients
2016
Background: Although presence of pulmonary metastasis is indicative of disease progression and its untreatable nature, in recent decades, numerous efforts have been made for treatment of these patients by surgical resection of metastatic lesions. The efficacy of this procedure has been variable in various reports and different diseases. This study aimed to evaluate the effect of metastatectomy in survival rate of patients with pulmonary metastases who underwent metastatectomy in Masih Daneshvari hospital. Materials and Methods: This was a retrospective study and we evaluated medical records of 99 patients suffering pulmonary metastasis who had been referred to our center during 1995-2007; out of which 48 patients who were qualified for metastatectomy underwent this operation. The required qualifications for surgery included: feasibility of resecting all metastatic lesions, tolerance of surgery by the patient, absence of metastatic lesions in organs other than the lungs, and control of primary disease. Information regarding the site of primary lesion and its pathology, time interval between the diagnosis of primary disease and metastasis, surgical morbidity and mortality, form of surgical procedure, type of incision, number of pulmonary metastases and survival rate of patients was collected. Patients were followed up via clinical visits. In case of insufficient clinical visits, we contacted the patient or his/her family and collected the rewired data. Obtained data were analyzed using SPSS software. To assess the patients' survival rate after the operation, Kaplan-Meier test was used. Results: Sixty-seven pulmonary metastatectomies were conducted on 48 patients (31 males and 17 females) in the age range of 16-86 years (mean 40 yrs). Twenty-five patients had unilateral and 23 had bilateral metastases. Among patients with bilateral metastases, 7 underwent single-phase metastatectomy while 16 underwent two or multi-phase metastatectomy. Surgical incisions were done through the following approaches: in 60 cases through postero-lateral thoracotomy, in 4 cases through mid-sternotomy and in 3 cases through bilateral anterior-transverse thoracotomy along with sternotomy (clamshell). In 61 cases pulmonary metastatic lesion was removed by wedge resection, in 14 cases by lobectomy and in one case by pneumonectomy. Mean number of resected lesions was 6.7 (range 1 to 59). Postoperative complications occurred in 10 patients (15%) including pneumothorax in 9 cases and chylothorax in one. No morbidity, mortality or life-threatening complications occurred in any of the patients. The mean survival of patients following metastatectomy was 22 months (range 1 to 128 months) and their 5-year survival was 24.5% Five patients had 5 years (60 months) or more survival. Conclusion: Although the understudy population was not homogenous pathologically, it seems that metastatectomy with acceptable morbidity, increases the survival of patients and in some cases results in their complete recovery.
Completion pneumonectomy: a valuable option for lung cancer recurrence or new primaries
World journal of surgical oncology, 2018
The preoperative selection of patients with lung cancer recurrence remains a major clinical challenge. Several aspects of this kind of surgery are still insufficiently evidence-based, with only a few series with more than 50 patients. A retrospective study on 29 patients who underwent a completion pneumonectomy for postoperative lung cancer recurrence or new primary was done in the period between October 2004 and December 2015. Inclusion criteria include complete (R0) first and second resections, histologically proven recurrent or new malignancy, complete pathohistological report after both operations, and exact data about the treatment outcome at the time of the last contact with patients or their families. There were 25 (86.2%) males and 4 (13.8%) females (M:F 6.2:1). In 13/29 patients, the interval between the first and second operations was less than 2 years, while in the remaining 16 patients, it was longer than 2 years. Concerning the operative stage distribution, stage I was ...
Standard versus extended pneumonectomy for lung cancer: what really matters?
World Journal of Surgical Oncology, 2014
Background: It is still not clear whether an intrapericardial pneumonectomy indicates a more advanced stage of the disease compared to a standard pneumonectomy. Methods: This was a retrospective study of 164 patients who underwent a pneumonectomy for lung cancer. The first group consisted of 82 patients who had a standard pneumonectomy and the second group was 38 patients who had a intrapericardial pneumonectomy, for both groups in the latest 5-year period. The third group was 44 patients with had a sleeve pneumonectomy in the latest 10-year period. The groups were compared in relation to the overall and stage-related survival, influence of T and N factors, operative morbidity and mortality. The statistics used were Kaplan-Meier, U-test, t-test, χ 2 test. Results: There was no statistically significant difference in stage distribution between standard and intrapericardial pneumonectomies; stages I, II, IIIA and IIIB occurred for 10.9% vs 2.6%, 30.5% vs 26.3%, 46.4% vs 65.8% and 12.2% vs 5.3% of patients, respectively. For patients who had a sleeve pneumonectomy, stage IIIA was significantly more frequent. Although the overall survival (63.5% vs 57.6%) and stage-related 5-year survival were better in the first compared to the second group, especially for stage IIIA (58.6% vs 42.6%), these differences were not statistically significant. There were no significant differences in operative morbidity and mortality between groups 1 and 2, but both were significantly higher in the third group (35.7% and 15.9%). Conclusions: An intrapericardial pneumonectomy does not always indicate a more advanced stage of the disease. The need for an intrapericardial pneumonectomy, either established preoperatively or during the operation, as a single factor, even for marginal surgical candidates, is not strong enough to reject these patients for surgery.