EARLY AND LONG-TERM RESULTS AFTER COMPLETION PNEUMONECTOMY

From January 1, 1978 to December 31, 1992, 37 patients underwent a com pletion pneumonectomy after a previous lobectomy (36 men and 1 woman; mean age, 60 years; range, 41 to 77 years). These account for 4.8% of 758 pneumonectomies. The purpose of the present study was to evaluate the operative results of completion pneumonectomy and long-term surviv al in patients with bronchogenic cancer. The initial lung resection ha d been performed for primary bronchogenic cancer in 23, metastatic thy roid adenocarcinoma in 1, and benign diseases in 13 (tuberculosis in 1 1, aspergilloma in I, and bronchiectasis in 1). Completion pneumonecto my was required for bronchogenic cancer in 32 (15 stage I, 6 stage II, 11 stage III). One patient had relapsing metastatic thyroid carcinoma , 2 had bronchiectasis, and 2 had a venous infarction after lobectomy. Four patients (10.8%) died perioperatively of the following causes: 1 fatal intraoperative bleeding, 1 fatal postoperative bleeding, 1 pneu -monia, and 1 malignant hypercalcemia. Median operative blood loss was 1,000 mL, and 19 patients experienced bleeding exceeding 1,000 mt (51 %). Six patients had intraoperative vascular injury. Nonfatal surgical complications occurred in 9 patients (24%), including 5 clotted hemot horaces, 3 empyemas, and 1 bronchopleural fistula. Four patients had m edical complications (2 pulmonary edemas, 1 sinus tachycardia, and 1 u nexplained fever). Twenty-three had an uneventful straightfoward recov ery (62%). The 32 patients with bronchogenic cancer were followed up u ntil date of death or July 1, 1993. Overall 5-year survival was 44.5% (59.7% for stage I, 41.6% for stage II, and 21.2% for stage III). We c onclude that there is an increased operative risk after completion pne umonectomy; however, this risk is acceptable with respect to long-term survival.