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