PLEUROPNEUMONECTOMY

The term pleuropneumonectomy refers to the combination of pneumonectomy with radical resection of the parietal pleura. Also it includes the resection of the diaphragm and the pericardium. In case that the latter two anatomical structures are removed, there is a need to reconstruct the defects, by using synthetic grafts.
Pleuropneumonectomy is considered as one of the most severe thoracic operations, and is associated with higher rate of peri-operative morbidity and mortality, compared to the typical pneumonectomy.
The most frequent indication to perform pleuropneumonectomy is the diffuse pleural and lung mesothelioma. It is rarely indicated as a treatment to bronchogenic carcinoma, stage IIIB, because of pleural metastatic disease (T4), on the condition that the patient has an excellent general condition, and had received preoperative chemotherapy, with significant response.
Also, but very rarely, the Thoracic Surgeon may be forced to perform pleuropneumonectomy as a treatment to bronchogenic carcinoma in case that the patient had suffered from tuberculosis of the pleural cavity and had developed pleural calcification, which may result in the formation of firm adhesions between the two leaflets of the pleura, so that the lung can’t be mobilized from the parietal pleura. Except for the above mentioned indications, I have performed this operation as a treatment for recurrent lung carcinoid. This happened in three (3) cases, all of them were relatively young female patients, who had been treated for the first time many years before the recurrence of their disease. All of them had recurrence in the intermedius bronchus, and throughout the pleural cavity without any pleural effusion. In the two cases pneumonectomy was performed, in combination with parietal pleura, diaphragm and pericardium resection. The pericardium and the diaphragm were replaced with synthetic graft. The third case was submitted to pneumonectomy in combination with the resection of the parietal pleura and a very small part of the diaphragm which was sutured directly and there was no need to use synthetic or another graft.
Postoperative haemorrhage and cardiac arrhythmia are among the most frequent complications after this operation.