Surgery of remnant lung after contralateral pneumonectomy is safe

Abstract

Objective: Surgery of the residual lung after contralateral pneumonectomy for progressing non-small cell lung cancer (NSCLC) is challenging because of high risk of the second procedure and uncertain longterm results. We aimed to assess the safety of surgery in this patientgroup.

Methods: Retrospective chart review was was carried out on patients undergoing surgery of remnant lung after contralateral pneumonectomy between 2001-2020. 10 right-/leftsided anatomical- and 10 extended pneumonectomies were performed with 85% R0 rate. 13 NSCLC and 7 other tumors were diagnosed.

Results: Median age was 61 (20-77) years, 55% females. The resection of the contralateral lung (18 wedge resections, 1 chest wall resection, 1 partial pleurectomy) was performed 18.5 months later (0–142) with 30- and 90 day 5% and 10% mortality. Morbidity after second surgery in 10/20 patients was predominantly caused by grade I minor (7/20) complications. Histology revealed 12 metastases, 4 secondary primary, 2 benign lesions and 2 patients with a synchronous- respective metachronous tumors. The overall survival (OS) and progression-free survival (PFS) were 37 [95%CI: 20,54] and 13 [95%CI: 0,38] months, respectively. The time interval between surgeries: more 12 months versus less than 12 months (9/14 vs 5/6 deaths) and complete (R0) resection of the primary tumor versus R1/R2 resection belonged to the factors influenced OS and PFS (fig).

Conclusions: Lung resection in the remaining lung after pneumonectomy can be performed in selected patients with acceptable morbidity and mortality. The prognosis is poor for patients with incomplete resection for the primary tumor and for those treated by second surgery earlier than 12 months after the pneumonectomy.