Additional pulmonary resection after pneumonectomy under ECMO support: a narrative review and representative case report

Patients who have undergone previous pneumonectomy may develop new or second primary
cancers, secondary cancers (metastases) or even recurrent malignant disease in the remaining single
lung. It is a common misbelief that additional pulmonary resection in a single lung is not feasible. These
cases should not be deemed unresectable solely due to the fact of new lesions in the remaining lung after
contralateral pneumonectomy. Individual treatment approaches should be based on a multidisciplinary case
discussion in specialized centers with high patient volume following meticulous preoperative evaluation and
cardiopulmonary assessment. In patients with sufficient cardiopulmonary reserves, an aggressive approach
with limited sublobar resection (segmentectomy or wedge resection) can be beneficial and provide good
functional and oncological outcome as well as maintenance of quality of life. In this narrative review the
evaluation, the management as well as the outcome of additional pulmonary resection after contralateral
pneumonectomy with benefits of using extracorporeal membrane oxygenation (ECMO) during these surgical
procedures is discussed. In addition, a patient that we encountered in our clinical work is dissected in further
detail. This case elucidates numerous critical considerations that the interdisciplinary team must make and
the challenging decision-making process in balancing feasibility, individual risks and expected benefits. The
surgical methodology employed and the outcomes are also highlighted.