LUNG RESECTION FOR RECURRENCE AFTER PNEUMONECTOMY FOR METASTASES

Resection of pulmonary recurrences after pneumonectomy for metastases is exceptional. Nevertheless, in carefully selected patients surgery o n the residual lung might be successfully performed From January 1987 to February 1996, 5 patients underwent metastasectomy on single lung a fter pneumonectomy performed for the same metastatic disease. There we re 3 male and 2 female with a mean age of 38 years at the time of surg ery on single lung All patients had a FEV 1 > 40%. One patient (n degr ees 1) had 2 consecutive operations (wedge resections) on the right lo wer lobe followed 17 months later by right inferior lobectomy for meta stases of soft tissue sarcoma. Three patients had only an operation on the residual lung (patient n degrees 2 had 2 wedge resections for car cinoma; patient n degrees 3 had 7 wedge resections for carcinoma patie nt n degrees 4 had 6 wedge resections for osteogenic sarcoma). The las t patient (n degrees 5) had 2 wedge resections on the right upper lobe and a large wedge resection on the right lower lobe for metastases of malignant corticosurrenaloma wing a cardiopulmonary femoro-femoral by -pass without cardiac arrest She postoperatively developed a right low er lobe venous infarction treated subsequently with a completion right lower lobectomy. She died in the postoperative course from cardioresp iratory insufficiency. The other patients had an uneventful postoperat ive course. Two patients (n degrees 2 and n degrees 4) died of their d isease 14 and 12 months respectively after the surgery on the residual lung by contrast 2 patients (40%) (n degrees 1 and n degrees 3) are s till alive without recurrences 36 and 27 months after the last resecti on. In selected patients aggressive surgery for metastases on the resi dual lung can be successfully performed but the benefits in terms of l ong-term disease-fee survival remain to be determined.