PNEUMONECTOMY AFTER CONTRALATERAL LOBECTOMY - IS IT REASONABLE

Conservative resection of a second primary lung cancer is desirable bu t not always feasible. We recently carried out three left pneumonectom ies for the removal of metachronous primary lung cancers in patients w ho had previously undergone right upper lobe resection for the treatme nt of bronchogenic carcinoma. In each patient, the results of pulmonar y function tests plus the findings from quantitative perfusion lung sc ans predicted a postpneumonectomy forced expiratory volume in 1 second of at least 1.00 L. All 3 patients had uncomplicated postoperative co urses, and were doing satisfactorily at follow-up 2 to 6 months later. One patient died 5 months after pneumonectomy due to unrelated causes , another died 8 months after pneumonectomy from infection after resec tion of a brain metastasis, and the third is doing well 15 months afte r pneumonectomy. The rarity of previously reported cases suggests that performing a pneumonectomy after contralateral lobectomy may be consi dered too radical. Our experience indicates the procedure may be consi dered if the patient's pulmonary function meets the standard criteria for pneumonectomy.