Is it safe and worthwhile to perform pulmonary resection after contralateral pneumonectomy

Abstract A best evidence topic was written according to a structured protocol. The question addressed was whether pulmonary resection is safeand worthwhile in patients who have undergone previous pneumonectomy. A total of 141 studies were identified using the reportedsearch, of which 8 represented the best evidence to answer the clinical question. Studies on multiple lung cancers with patients undergo-ing subsequent pulmonary resection after previous pneumonectomy, without outcome data specifically for this group of patients and casereports, were not included in this analysis. The authors, date, journal, country, study type, population, outcomes and key results are tabu-lated. All studies were retrospective. In total, 102 patients underwent pulmonary resection after contralateral pneumonectomy, of which96 had sublobar resections and 6 had lobectomies. Postoperative complications, reported in four of the eight studies, ranged from 21 to44% (mean from four studies 36.8%). Fourof the eight studies reported no mortalityafter pulmonary resection following pneumonectomy,whereas the other four reported mortality rates from 6.7 to 43%. For patients undergoing sublobar resections, the postoperative mortalitywas 6.2% (6/96), while for those submitted to lobectomy, mortality was 33.3% (2/6). Five-year survival rates ranged from 14% for metastaticdisease to 50% for metachronous lung cancer. Due to the infrequent situation of a patient being considered for a pulmonary resectionafter contralateral pneumonectomy, this analysis was based on a limited number of patients from eight reports. Nevertheless, analysis ofthe data suggests that pulmonary resection for metastatic or metachronous disease can be performed with acceptable morbidity and lowmortality in appropriately selected patients who have previously undergone a pneumonectomy. Sublobar resection is the treatment ofchoicewhenever possible, for which long-term results are rewarding especially for patients with metachronous lung cancer.Keywords:Lung cancer •Pneumonectomy •Multiple lung cancers •Metastatic disease