the risk of anatomical resection in post-surgical dominant lung

Objective. Patients who underwent previous thoracotomy develop dominant perfusion on the contra lateral side but the risk of performing an iterative pulmonary resection on a post-surgical dominant lung has never been investigated. It was the aim of this prospective, single-center study. Methods. Since January 2003, patients undergoing resection for lung cancer or metastatic disease on a post-surgical dominant lung were divided into 2 groups: those receiving anatomical resection (group A) and those undergoing single or multiple wedge resections (group B). All clinical data were collected into a dedicated database in order to compare overall mortality and respiratory complication rate between the 2 groups. Results. The study population was composed of 62 patients operated on a dominant lung in the last 48 months. Twenty-four of them underwent anatomical resection (males 17, median age 64, group A) and 33 underwent non-anatomical resection (males 23, median age 66, group B). The 2 groups were homogeneous in terms of preoperative FEV1 (median group A 70%, group B 70%, Dlco% (median group A 84%, group B 91%) and perfusion of the operated lung (median group A 67%, group B 66%). Type of operation consisted of 9 and 8 respectively right and left upper lobectomy,3 middle lobectomy and 4 left lower lobectomy in group A; 17 and 16 respectively single and multiple pulmonary resections in group B. No postoperative death was recorded in both groups. In group A, 5 respiratory complications were recorded (21%) and one of them required reintubation and prolonged ICU stay. The other cases has respiratory failure successfully treated by non-invasive ventilation. In group B, 1 respiratory complication (3%, Chi square 0.04) was recorded in a patients who underwent single wedge resection after bilobectomy. Conclusions. An iterative anatomical resection on a post-surgical dominant lung is feasible however the postoperative morbidity risk is increased .