Pneumonectomy for benign disease: Analysis of the early and late outcomes

OBJECTIVES: To analyse the indications, operative techniques, postoperative morbidity, mortality and long-term outcomes of patients who underwent pneumonectomy for benign lung disease. METHODS: We retrospectively reviewed our institutional database for patients who underwent a pneumonectomy for benign lung disease from January 1991 to June 2010. The data were queried for the indications for surgery, details of operative technique, development of perioperative complications, mortality and long-term survival. RESULTS: There were 32 patients, 19 men (59%) and 13 women, with a mean age of 48 years (17-78). Indications for pneumonectomy included pulmonary tuberculosis in 10 patients (31%), chronic septic lung disease in seven (22%), invasive opportunistic infections in five (16%), fibrosing mediastinitis in four (12%) and other in six (19%). Pneumonectomies were left-sided in 17 (53%) and right-sided in 15 patients; nine (28%) were completion pneumonectomies. Intraoperatively, intrapericardial isolation was performed in 21 (66%) patients and extrapleural dissection in seven (22%); bronchial reinforcement was performed in 25 (78%). Operative mortality occurred in two (6%) patients. Major complications occurred in 12 (38%) patients; no patient developed bronchopleural fistula or postpneumonectomy empyema requiring intervention. Overall 5-year survival was 75% (95% CI 56.2-87.9), with a mean follow-up of 99 months. CONCLUSIONS: Pneumonectomy for benign disease is a high-risk procedure performed for a variety of indications. A detailed operative technique is of the utmost importance to minimize postoperative morbidity and mortality. Despite an increased perioperative risk, the long-term outcomes can be especially satisfactory. Pneumonectomy for benign disease should continue to be a treatment option for carefully selected patients.