Two cases of completion pneumonectomy after left upper sleeve lobectomy

Abstract

This report describes two patients who underwent completion pneumonectomy about 2 years after undergoing left upper sleeve lobectomy. A 68-year-old man had received induction chemotherapy/radiothe-rapy and undergone surgery for small cell lung cancer 21 months previously. He underwent completion pneumonectomy for squamous cell lung cancer diagnosed as a second non-metastatic primary lung cancer. As of 6 years and 8 months after the second operation, he was alive and disease-free. A 70-year-old man who had been treated surgically for squamous cell lung cancer 24 months before, experienced local recurrence and underwent completion pneumonectomy. The operation was initiated by median sternotomy and accomplished by posterolateral thoracotomy. The left main pulmonary artery was dissected with an intrapericardial approach to prevent vascular injury. The patient died of the recurrent disease 20 months after the second operation. At the second operation, both patients were found to show the main pulmonary artery bending and ascending toward the apex of the lung to a greater extent compared to those undergoing upper lobectomy. Our experience in the second patient suggests that median sternotomy may facilitate intrapericardial management of lung vessels during completion pneumonectomy.