Completion pneumonectomy—indications, practical problems and open questions

Dragan Subotic, Didier Lardinois

Abstract

There are three groups of indications for completion pneumonectomy (CP): (I) CP after surgery for lung cancer (LC); (II) CP after surgery for multidrug-resistant (MDR) and extensively-resistant (XDR) tuberculosis (TB); (III) CP as the treatment option for complications of previous surgery. As for CP for LC, according to data from 10 studies with a sufficient sample size, 5-year survival was under 30% in four studies, 30–40% in additional three studies, whilst in three studies it was over 40%. The evidence reveals slightly (38% vs. 41%) to significantly (44.6% vs. 29.2%) better survival for second primaries, vs. LC recurrence. Based on around 12% reported operative mortality and <40% operative morbidity, these complication rates seem to be comparable with those after standard pneumonectomy. Currently, radiation treatment remains an alternative treatment, especially for functionally inoperable or technically unresectable patients. In patients with MDR/XDR-TB the indications for CP are: chronic, persistent disease, persistent cavitary disease or destroyed lung, persistently positive sputum, hemoptysis, bronchopleural fistula (BPF), and bronchial stenosis. A wide range of complication rate is reported—23% to 63% morbidity and 0% to 25% mortality. The 4.0–8.5% operative mortality of pneumonectomy for inflammatory lung disease seems to mirror the situation in most of the centers. As for the third group of indications (lung torquation after the lung resection and the CP after pleural empyema), the evidence is in form of case reports or small case series.