Completion pneumonectomy: Current indications, complications, and results

Objective: Completion pneumonectomy is reported to be associated with high morbidity and mortality, especially when done in patients with benign disea se; We review our 9 years of experience with this operation to evaluate the postoperative outcome and long-term results of various indications. Methods: Between January 1990 and December 1998, 66 consecutive patients un derwent completion pneumonectomy (6.8% of all pneumonectomies), and their c ases were retrospectively reviewed. The indication was benign disease in 17 patients and malignant disease in 49 patients. In patients with malignant indications there were 14 local recurrences, 4 second primary tumors, 5 met astatic diseases, and 26 indications because of incomplete initial resectio n. Results: There were no intraoperative deaths, and the postoperative mortali ty rate was 7.6%. Complications were encountered in 32 (53%) patients, with out any significant difference between benign indication (71%) and malignan t indication (47%; P = .0923). Bronchopleural fistula was encountered in 5 (7.6%) patients, and empyema was encountered in 7 (11%) patients. The actua rial 5-year survival was 57% for all patients, 65% for those with benign in dications, and 54% for those with malignant indications (60% for local recu rrence, 50% for second primary tumor, and 56% for incomplete resection), wi thout any difference between benign and malignant indications (P = .9478). Conclusions: Completion pneumonectomy can be performed with acceptable mort ality and morbidity, even in patients with benign disease. Patients with pr eoperative infection can be managed with bronchial stump covering and adequ ate postoperative drainage. Although complications are common, they can suc cessfully be managed with a proper understanding of them.