COMPLETION PNEUMONECTOMY FOR LUNG METASTASES - IS IT JUSTIFIED

Objective: To evaluate the postoperative outcome and long-term results of patients who underwent iterative and extended pulmonary resection leading to completion pneumonectomy for pulmonary metastases. Methods: From January 1985 to December 1995, 12 patients (mean age 45 years) u nderwent completion pneumonectomy for pulmonary metastases. These pati ents represent 1.5% of all pulmonary metastases operated on. There wer e 5 sarcoma and 7 carcinoma patients. Before completion pneumonectomy, 8 patients had only one pulmonary resection (wedge resection, 2; segm entectomy, 2; lobectomy, 4), 3 patients had two operations and finally , 1 patient had multiple bilateral wedge resections and 1 lobectomy. T he median interval time between the last pulmonary resection and compl etion pneumonectomy was 13.5 months (range 1-24 months). Results: Ther e were 10 left and two right completion pneumonectomies. Three patient s had an extended resection (1 carina; 1 chest walk; 1 pleuropneumonec tomy). Intrapericardial dissection was used in 3 patients. Two patient s died within 30 days of the operation: I died of postoperative compli cations (8.3%) whereas the other died of rapidly evolving metastatic d isease. The remaining 10 patients had an uneventful postoperative cour se. Only 1 patient is still alive and free of disease 69 months after completion pneumonectomy. One patient is alive with disease, another w as lost to follow-up, 9 patients died of metastatic disease. The media n survival time after completion pneumonectomy was 6 months (range 0-6 9 months). The estimated 5-year probability of survival was 10% (95% C I: 2-40%). Conclusions: Indications for both iterative and extended pu lmonary resection for PM maybe discussed only in highly young selected patients; the extremely poor outcome of our subgroup of patients shou ld lead to even more restrictive indications of CP for pulmonary metas tatic disease. (C) 1997 Elsevier Science B.V.