Subsequent Pulmonary Resection in Patients after Pneumonectomy

Objective. In this retrospective study, we investigated the feasibility of subsequent pulmonary resection after pneumonectomy. Methods. Between 1987 and 2002, 383 patients underwent pneumonectomy at our hospital. Four (1%) of these patients underwent subsequent pulmonary resection in the contralateral lung. The clinicopathological records were reviewed with regard to tumor histology, pathological stage, preoperative and postoperative pulmonary function, the interval between subsequent pulmonary resection and pneumonectomy, mode of contralateral pulmonary resection, complications, mode of recurrence, and outcome. Results. Histology of the tumor treated by pneumonectomy was adenocarcinoma in 2 patients, squamous cell carcinoma in 1, and adenoid cystic carcinoma in 1. The postsurgical stage in patients who had undergone pneumonectomy was stage IA in 1 patient, stage IIB in 2, and stage IV in 1. Subsequent pulmonary resection was performed 7 to 53 months (mean, 25.5 months) after pneumonectomy. All patients had subsequent tumors arising in the periphery of the lung and underwent partial lung resection. Complications occurred in 2 patients, in both of whom the complications were respiratory-related. One of them died of respiratory failure postoperatively. Two patients had recurrent disease: one patient had recurrent tumor in the trachea and received radiotherapy and stent insertion, and is alive at 78 months with recurrence, while the other patient died from cancer recurrence after 63 months. Conclusion. Subsequent resection after pneumonectomy is regarded as the treatment of choice if the tumor is located in the periphery of the lung and can be curable by partial resection.