Pulmonary resection after pneumonectomy

Thoracic Surgery Clinics
Douglas E Wood

Abstract

Patients who have a lung cancer in the residual lung after pneumonectomy should not be automatically excluded for surgical consideration. These patients should be carefully staged and evaluated physiologically. The most important initial differentiation is to distinguish a true second primary lung cancer from metastatic recurrent lung cancer. Meticulous staging with chest CT, PET, brain MRI, and mediastinoscopy should be able to successfully exclude metastatic disease, multifocal disease, or locally advanced tumors. Only patients who have stage I disease are candidates for this type of extended resection. Ideally, these patients should have small peripheral tumors that can be encompassed with a low-volume wedge resection. More extended resections, such as segmentectomy or right middle lobectomy, may be considered in some patients but seem to bear a higher operative morbidity and mortality. The need for an upper or lower lobectomy after contralateral pneumonectomy is probably an absolute contraindication to surgical resection. To tolerate pulmonary resection after pneumonectomy, and to obtain the desired survival benefit, patients should have a good to excellent performance status, no serious comorbidities, and a ppoFEV1 greater...Continue Reading

References

Oct 1, 1991·The Annals of Thoracic Surgery·T K RosengartM Burt
Jan 1, 1991·The Annals of Thoracic Surgery·A G FleisherC L Robinson
Oct 1, 1989·Thorax·P C van BodegomR G Vanderschueren
Sep 1, 1985·The Annals of Thoracic Surgery·C F KittleW H Warren
Jan 1, 1995·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·M Ribet, P Dambron

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Citations

Dec 3, 2014·Thoracic Surgery Clinics·Olaf MercierShaf Keshavjee
May 25, 2010·The Annals of Thoracic Surgery·Karsten WiebeChristof Schmid
Aug 1, 2009·Asian Cardiovascular & Thoracic Annals·Jorge QuirogaRamiro Ledo
Nov 11, 2017·The Korean Journal of Thoracic and Cardiovascular Surgery·Dong Hoon KangSung Hwan Kim

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