Open left pneumonectomy: ancillary considerations

Pneumonectomy becomes an infrequently surgical procedure, representing now less than 10% of all types of major pulmonary resections performed to cure lung cancer (1). The performance of a pneumonectomy for lung cancer remains a high-risk surgical procedure despite optimization of surgical technique and postoperative care. Therefore, general thoracic surgeons try to avoid pneumonectomy whenever possible because of the reported poor quality of life, increased morbidity and mortality, and the thought that a pneumonectomy is, in itself, a disease (2). However, sometimes a pneumonectomy is the only way to achieve a R0 resection, typically for centrally located tumors. Actually, left pneumonectomy is a more easily accepted and performed procedure because its associated perioperative mortality is half lower than that of a right pneumonectomy (1,3). Theoretic rationales supporting these clues are a smaller parenchymal volume removed and a bronchial stump less exposed to the pleural space, thereby lessening the incidence of post-pneumonectomy respiratory failure and bronchial leaks, respectively. As a result, complex bronchoplastic and angioplastic lung sparing resections are less likely to be used on the left side (4). Indeed, current mortality and morbidity figures of left pneumonectomy are very similar to those of complex extended lobectomies (1,4). Therefore, left pneumonectomy should remain a valuable tool in every thoracic surgeon’s armamentarium.