COMPLETION PNEUMONECTOMY - INDICATIONS AND OUTCOME

Completion pneumonectomy has been associated with higher rates of morb idity and mortality and this is reflected in the selection of cases an d the indications for the procedure, During a period of 14 years from January 1980 to November 1993, 38 completion pneumonectomies were done by our surgical team, representing 5.1% of all pneumonectomies. There were 24 right and 14 left completion pneumonectomies done in 26 male and 12 female patients with an average age of 61 years (range from 29 to 77 years), Lung malignancy accounted for 26 of these cases in which the indication included local recurrence in 10, second primary tumor in 9, malignancy that developed after resection for benign disease in 2, and pulmonary metastasectomy in 5 cases. Benign diseases were the i ndication in 12 cases: tuberculosis in 4, bronchiectasis in 4, aspergi llosis in 1, and postoperative complications in 3, Additional surgical procedures were necessary in 7 cases: chest wall resection with inser tion of prosthesis in 3, thoracoplasty in 2, and omental flap in 2, Th ere was 1 early postoperative death after 5 weeks from adult respirato ry distress syndrome, There was no occurrence of bronchopleural fistul a, and the 18% associated morbidity rate was a result of bleeding nece ssitating reexploration in 3 cases, prolonged ventilation in 2, and ch ronic empyema in 2, Six of these complications (86%) occurred in the g roup with benign disease, Completion pnenmonectomy can be done with an acceptable morbidity in selected patients, Careful technique is impor tant to secure hemostasis and to avoid fistulas. The complication rate is higher when infective disease is involved.