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Ann Thorac Surg 1998;66:308-309
© 1998 The Society of Thoracic Surgeons

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Correspondence

Postpneumonectomy contralateral thoracotomy for carcinoma

^a 454 Pennsylvania Ave, Glen Ellyn, IL 60137, USA

To the Editor

In reviewing the article by Spaggiari and associates [1] concerning resection of carcinoma of a lung from the residual lung after pneumonectomy for a bronchogenic carcinoma, I found this to be an interesting topic. Pulmonary resection and other operations, both thoracic and nonthoracic, are required on occasion in these postpneumonectomy individuals. Such treatment may be approached in a number of ways using general anesthesia, including in the patient who may subsequently require a mediastinal or contralateral thoracic operation. Some of these may be at a greater risk than others and therefore may eventually not have the procedure performed despite the apparent necessity. Others may tolerate general anesthesia and major operative intervention, not only on one occasion, but on multiple occasions.

Here are four examples: Patient 1 was a middle-aged woman status post right pneumonectomy for squamous cell carcinoma, in whom a second carcinoma developed involving the left main bronchus. Left transthoracic bronchial resection with cardiopulmonary bypass was rejected by ourselves and a major teaching center. Patient 2 was status post right pneumonectomy and had the following subsequent procedures performed: a right thoracoplasty, coronary artery bypass with cardiopulmonary bypass, resection of an abdominal aortic aneurysm, and a cholecystectomy. Patient 3 had a left pneumonectomy followed by resection of the right upper lobe lesion and mediastinal node dissection in 3 years. The last patient had an extended right pneumonectomy followed by a left upper lobe segmentectomy for a second primary carcinoma and resection of an abdominal aortic aneurysm. The latter 3 patients all tolerated major operations and general anesthesia with average hospital stays similar to those of Spaggiari and associates’ patients.

I have advocated a minimal incision, avoidance of fracture of the ribs, adequate preoperative evaluation, and careful postoperative observation for these patients. I encourage continued consideration of this select group for surgical intervention.

References

1. Spaggiari L., Grunewald D., Girard P., et al. Cancer resection on the residual lung after pneumonectomy for bronchogenic carcinoma. Ann Thorac Surg 1996;62:1598-1602.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Raymond A. Dieter, Jr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dieter, R. A. Search for Related Content PubMed PubMed Citation Articles by Dieter, R. A., Jr