Pulmonary Resection for Metachronous Lung Cancer Following Contralateral Pneumonectomy (original) (raw)
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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.
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. #
Completion pneumonectomy for lung metastases: is it justified?
European Journal of Cardio-Thoracic Surgery, 1997
To evaluate the postoperative outcome and long-term results of patients who underwent iterative and extended pulmonary resection leading to completion pneumonectomy for pulmonary metastases. Methods: From January 1985 to December 1995, 12 patients (mean age 45 years) underwent completion pneumonectomy for pulmonary metastases. These patients represent 1.5% of all pulmonary metastases operated on. There were 5 sarcoma and 7 carcinoma patients. Before completion pneumonectomy, 8 patients had only one pulmonary resection (wedge resection, 2; segmentectomy, 2; lobectomy, 4), 3 patients had two operations and finally, 1 patient had multiple bilateral wedge resections and 1 lobectomy. The median interval time between the last pulmonary resection and completion pneumonectomy was 13.5 months (range 1 -24 months). Results: There were 10 left and two right completion pneumonectomies. Three patients had an extended resection (1 carina; 1 chest wall; 1 pleuropneumonectomy). Intrapericardial dissection was used in 3 patients. Two patients died within 30 days of the operation: 1 died of postoperative complications (8.3%) whereas the other died of rapidly evolving metastatic disease. The remaining 10 patients had an uneventful postoperative course. Only 1 patient is still alive and free of disease 69 months after completion pneumonectomy. One patient is alive with disease, another was lost to follow-up; 9 patients died of metastatic disease. The median survival time after completion pneumonectomy was 6 months (range 0 -69 months). The estimated 5-year probability of survival was 10% (95% CI: 2-40%). Conclusions: Indications for both iterative and extended pulmonary resection for PM may be discussed only in highly young selected patients; the extremely poor outcome of our subgroup of patients should lead to even more restrictive indications of CP for pulmonary metastatic disease. © 1997 Elsevier Science B.V.
Thoracoscopic partial lung resection following pneumonectomy: a report of three cases
Journal of Cardiothoracic Surgery, 2019
Background The prognosis of patients who undergo unilateral pneumonectomy and subsequently develop a contralateral pulmonary tumor can be improved by tumor resection. Thus, surgery is a treatment option if the patient’s pulmonary function and performance status are satisfactory. To date, there have been only few cases reporting thoracoscopic lung resection for pulmonary tumor after contralateral pneumonectomy because of the difficulty in respiratory management during surgery. Thoracoscopic surgery requires the maintenance of the operative field to allow the lung to collapse, and in partial lung resection we need to identify tumor localization. The identification of a tumor lesion just inferior to the pleura is easy; however, the identification of a tumor lesion in the deep parts is difficult. The tumor in the deep part of the lung segments can be easily located if the tumor-affected lobe is allowed to completely collapse. Therefore, ventilation technique should be modified according...
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 ...
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
Journal of Thoracic Disease
Background: Locoregional recurrence rates for non-small cell lung cancer (NSCLC) remain high, even following curative surgical resection. While national guidelines advocate surgical resection for locoregional recurrence, it is rarely offered when resection would require completion pneumonectomy, which available literature associates with a 12-36% perioperative mortality and 40-80% morbidity. Additionally, survival advantages to radical surgery in this scenario are largely unknown, particularly because available series often include patients undergoing completion pneumonectomy for benign indications or metastatic disease from other primary sites, making extrapolation to primary lung cancer patients challenging. As systemic therapy options continue to evolve, particularly as it relates to immunotherapy, we expect that there will be more and more opportunities for locoregional surgical control. The aim of this study was to evaluate outcomes following completion pneumonectomy for recurrent NSCLC. Methods: We retrospectively reviewed all patients who underwent completion pneumonectomy for recurrent NSCLC at our institution between 2000 and 2015. Factors affecting perioperative morbidity and mortality, as well as overall survival, were analyzed. Results: Between 2000 and 2015, 28 patients underwent completion pneumonectomy for recurrent lung cancer (14 female, 14 male). The median age was 64.2 years (range, 36.7-84.0). There were 11 left-sided and 17 right-sided operations. Fourteen patients (50.0%) underwent chemotherapy or chemoradiotherapy prior to surgery. Perioperative morbidity was seen in 13 of 28 (46.4%) patients, and atrial fibrillation was the most common complication. Mortality at 30-and 90-day intervals was 3.6%, and 14.3% respectively. Five-year overall survival was 43.1% and was not associated with preoperative chemotherapy or chemoradiotherapy use. Patients over 70 years old (n=5) experienced a statistically higher rate of postoperative complications (100.0% vs. 34.8%, P=0.013), and this translated into a higher mortality rate at 60 and 90 days. Left-sided resections were associated with increased risk of recurrent laryngeal nerve injury (RLN) compared to rightsided resections (36.4% vs. 0%, P=0.016), and those patients with RLN injury were more likely to be reintubated (50.0% vs. 4.2%, P=0.04). Bronchopleural fistula occurred in 1 patient (3.6%). Conclusions: Completion pneumonectomy is a viable treatment option for patients with recurrent NSCLC. We attribute our low risks of major morbidity, such as bronchopleural fistula, to careful patient selection and technique. In patients over 70 years, morbidity is higher which should inform discussion regarding surgical options.
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.
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.
Pneumonectomy for Lung Cancer After Preoperative Concurrent Chemotherapy and High-Dose Radiation
The Annals of Thoracic Surgery, 2010
Background. We studied the clinical characteristics and outcomes of patients undergoing pneumonectomy after preoperative concurrent chemoradiation for non-small cell lung cancer. Methods. Clinical records of patients with non-small cell lung cancer who underwent pneumonectomy at our institution between 1995 and 2005 after preoperative concurrent chemoradiation were reviewed retrospectively. Results. Twenty-nine patients underwent pneumonectomy after preoperative concurrent chemoradiation. Of the 21 men and 8 women who were treated, 1 had stage IIB (T3N0M0) and the remainder had stage IIIA or IIIB non-small cell lung cancer. Mean patient age at surgery was 53.4 years. There were 15 right pneumonectomies, of which 2 were for pancoast tumors. All patients received concurrent preoperative chemoradiation. Mean total radiation dose was 61.1 Gy. All patients went on to have complete (R0) resection by pneumonectomy. Pathologic complete response was found in 16 patients (55.2%). All patients were discharged alive from the hospital after pneumonectomy. Median hospital length of stay was 5 days (mean 8.6). Ninety-day mortality after surgery was 3.4% (n ؍ 1). Recurrences have been found in 11 patients (38%), including brain metastases (n ؍ 6), bone metastases (n ؍ 4), liver metastases (n ؍ 2), and cervical lymph node metastases (n ؍ 2). One patient had a contralateral new primary lung cancer develop 70 months after undergoing pneumonectomy. Estimated 5-year disease-free survival is 48%. Median survival time has not been reached. Conclusions. Pneumonectomy can be performed safely after preoperative concurrent chemoradiation, even with high-dose radiation. The frequency of disease recurrence in the brain underscores the need to evaluate the role of prophylactic cranial radiation in non-small cell lung cancer.