Surgery after pneumonectomy: it is all a matter of balance

Pneumonectomy is a feasible and sometimes necessary therapeutic option in case of resectable central lung cancer (1); nevertheless, postoperative morbidity and mortality are higher compared with more limited lung resections. Consequently, pneumonectomy is often defined as “a disease itself” and a careful preoperative work-up providing good lung function and performance status is required (2). In case of a second metachronous cancer in the contralateral lung after pneumonectomy, the correct choice on the best therapeutic path to follow is not always easy to make and a multidisciplinary discussion is therefore mandatory. However, surgical option should not be a priori excluded, even though locally advanced cancer stages, lymph-node involvement after the first intervention as well as an impaired pulmonary function and cardiovascular performance status should be considered exclusion criteria for any additional lung resection.