Pneumonectomy after contralateral lobectomy: is it reasonable?

Conservative resection of a second primary lung cancer is desirable but not always feasible. We recently carried out three left pneumonectomies for the removal of metachronous primary lung cancers in patients who had previously undergone right upper lobe resection for the treatment of bronchogenic carcinoma. In each patient, the results of pulmonary function tests plus the findings from quantitative perfusion lung scans predicted a postpneumonectomy forced expiratory volume in 1 second of at least 1.00 L. All 3 patients had uncomplicated postoperative courses, and were doing satisfactorily at follow-up 2 to 6 months later. One patient died 5 months after pneumonectomy due to unrelated causes, another died 8 months after pneumonectomy from infection after resection of a brain metastasis, and the third is doing well 15 months after pneumonectomy. The rarity of previously reported cases suggests that performing a pneumonectomy after contralateral lobectomy may be considered too radical. Our experience indicates the procedure may be considered if the patient's pulmonary function meets the standard criteria for pneumonectomy.