Pulmonary resection after pneumonectomy.

Limited lung resection for second primary lung cancer after pneumonectomy is a worthwhile procedure in appropriately selected patients because it carries a low operative risk and allows for longterm survival with good quality of life. Operations for metachronous cancers had a survival benefit that approximated the expected survival for primary lung cancer. The prognosis is poor for patients with N2 status and for those treated by second surgery earlier than 2 years after the first procedure. Careful selection of potential candidates for remaining lung surgery with special attention to functional cardiopulmonary reserve and lung cancer extension is mandatory for optimal early postoperative results and a long-term beneficial effect. Wedge resection with negative margins is the preferred procedure for peripheral tumors. Central tumors would benefit more from segmentectomy. With the exception of middle lobectomy, lobectomy should be avoided because of its negative impact on cardiopulmonary reserve and outcomes. In highly selected patients, surgical resection of a second primary NSCLC after pneumonectomy following these principles may achieve a 5-year survival rate of up to 63%. SBRT has shown promising early results as an alternative to surgical resection in inoperable patients.