PURPOSE: Completion pneumonectomy refers to removal of parenchyma residue by a previous resection. After a surgical resections for non small cell carcinoma, if a local relapse or new primary bronchogenic carcinoma is detected, second operation should be attempted. Aim of our study was to analyze results and long term prognosis after completion pneumonectomy.
METHODS: In a case-series of 55 completion pneumonectomies for relapsing lung cancer or second primary tumor, first operation was lobectomy in 45 (82%), bilobectomy in 7 (13%) and segmentectomy in 3 (5%). Histology was squamous-cell carcinoma in 27 cases (49%), adenocarcinoma in 24 (44%) and giant cell carcionoma in 4 (7%). Thirty-four patients (62%) had stage I disease, 13 (24%) stage II, 6 (11%) stage III and 2 (3%) stage IV. Disease free interval after first operation was 29.70±27.52 months (median: 23; range: 6-163).
RESULTS: Thirty-two right (58%) completion pneumonectomies and 23 left-ones (42%) were performed. Overall postoperative mortality was 10% and morbidity 38%. Recurrent tumors were squamous carcinomas in 23 cases (42%), adenocarcinomas in 28 (51%), giant cell carcinoma in 4 (7%). In 8 patients we had different histology (15%). Twenty-nine subjects had a second primary tumor (53%) while 26 a local recurrence (47%). Seventeen patients had stage I (52%), 12 stage II (22%) and 8 stage III disease (26%). Average survival after completion pneumonectomy was 56.42±49.52 months (median: 38 months; range: 4-225). Five-year survival rate was 43%. Metachronous primary disease was associated with a higher survival rate compared with local recurrence (5-year survival: 49% vs. 31%). Radiotherapy before redosurgery resulted in a significantly higher morbidity rate.
CONCLUSION: Completion pneumonectomy is a technically challenging operation, which is accompanied by high postoperative morbidity rates. Our 43% 5-year survival rate after redo surgery justifies the risk of an aggressive surgical approach when the baseline clinical condition is good and mediastinal nodes are negative.
CLINICAL IMPLICATIONS: The importance of a preoperative patient selection in order to obtain long term survival with an acceptable quality of life cannot be overemphasized.
DISCLOSURE: Pier Brega-Massone, None.