Original article: general thoracic
Subsequent pulmonary resection for bronchogenic carcinoma after pneumonectomy

Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.
https://doi.org/10.1016/S0003-4975(02)03688-3Get rights and content

Abstract

Background. Patients who have undergone a pneumonectomy for bronchogenic carcinoma are at risk of cancer in the contralateral lung. Little information exists regarding the outcome of subsequent lung operation for lung cancer after pneumonectomy.

Methods. The records of all patients who underwent lung resection after pneumonectomy for lung cancer from January 1980 through July 2001 were reviewed.

Results. There were 24 patients (18 men and 6 women). Median age was 64 years (range, 43 to 84 years). Median preoperative forced expiratory volume in 1 second was 1.47 L (range, 0.66 to 2.55 L). Subsequent pulmonary resection was performed 2 to 213 months after pneumonectomy (median, 23 months). Wedge excision was performed in 20 patients, segmentectomy in 3, and lobectomy in 1. Diagnosis was a metachronous lung cancer in 14 patients and metastatic lung cancer in 10. Complications occurred in 11 patients (44.0%), and 2 died (operative mortality, 8.3%). Median hospitalization was 7 days (range, 2 to 72 days). Follow-up was complete in all patients and ranged between 6 and 140 months (median, 37 months). Overall 1-, 3-, and 5-year survivals were 87%, 61%, and 40%, respectively. Five-year survival of patients undergoing resection for a metachronous lung cancer (50%) was better than the survival of patients who underwent resection for metastatic cancer (14%; p = 0.14). Five-year survival after a solitary wedge excision was 46% compared with 25% after a more extensive resection (p = 0.54).

Conclusions. Limited pulmonary resection of the contralateral lung after pneumonectomy is associated with acceptable morbidity and mortality. Long-term survival is possible, especially in patients with a metachronous cancer. Solitary wedge excision is the treatment of choice.

Section snippets

Material and methods

Between January 1, 1980 and June 30, 2001, 772 patients underwent pneumonectomy at the Mayo Clinic in Rochester, MN, for lung cancer. Twenty-four (3.1%) of these patients underwent subsequent resection for lung cancer in the contralateral lung. Patients who underwent pulmonary resection for benign disease or other malignancies were excluded. The records of these patients were analyzed for age, sex, preoperative conditions, pulmonary function, initial cell type and postsurgical stage, extent of

Results

There were 24 patients (18 men and 6 women) who underwent 25 subsequent pulmonary resections for lung cancer after pneumonectomy. Median age at the subsequent resection was 64 years and ranged from 43 to 84 years. Twenty-three patients (95.8%) were current or former smokers. Nine patients (37.5%) had a completion pneumonectomy. Twelve patients (50%) had a previous right pneumonectomy. Cell type of the original cancer was squamous cell carcinoma in 10 patients, adenocarcinoma in 8, large cell

Comment

Patients with a completely resected bronchogenic carcinoma have a 5% to 10% risk of having a new lung cancer [3] and a 30% to 80% risk of having recurrent disease 2, 4. This percentage will continue to increase as patient survival improves. Nevertheless, surgical resection for bronchogenic carcinoma of the residual lung after pneumonectomy is rarely reported. Fewer than 100 cases have been published in the literature during the last 35 years 5, 7, 8, 9, 10, 11, 12, 13, 14. Factors limiting

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