Pneumonectomy is an injury or still an effective method of treatment?

Abstract

Introduction: Despite the constant decrease of performed pneumonectomies in recent years, it is still necessary for patients with non-small cell lung cancer (NSCLC) due to the local progression of the disease.

Material & Method: Among almost 1000 thoracic procedures during the last 4 years 41 patients (4.1%) underwent pneumonectomies for locally advanced disease. There were 36 men and 5 women ranging in age from 56 to 78 years. The diagnostic process included (CT scan, PET/CT), endoscopy (bronchofibroscopy, EBUS-TBNA and Tblind TBNA) and in some cases transththoracic needle aspiration biopsy. Full assessment of the cardiovascular and respiratory status of the patients was performed including cardiac ultrasound, FEV1, DLCO and Ventilation/Perfusion (V/Q) scan. Stages were either IIB or IIIA. Four patients had neoadjuvant chemotherapy and in 3 the procedure was considered salvage therapy, since they developed a shunt and they were O2 dependent.

Results: After obtaining an informed consent the patients were led to surgery and under general anesthesia 32 of them were submitted to extrapericardial pneumonectomy and the rest to intrapericardial one. Perioperative mortality reached 2.4% due to myocardial infarction. Invasive physiotherapy diminished perioperative morbidity but hospitalization was longer ranging from 7 to 14 days. No bronchopleural fistula occurred.

Conclusion: Despite the larger perioperative trauma careful preoperative assessment, operative technique and postoperative care achieve favourable outcomes in pneumonectomy, which in some cases can be life-saving with even a better quality of life for the patient.