ESTS Presidential address Pneumonectomy: historical perspective and prospective insight

I would like to thank you for the honour of electing me as your President. My purpose will be today to share with you some considerations about an operation that has crossed the 20th century by typifying the greatness and servitude of thoracic surgery, while keeping many of its mysteries at the beginning of the 21st, I mean pneumonectomy. The first pneumonectomy was performed in multiple stages by Macewen in 1895 in a patient with tuberculosis and empyema. Further attempts with one-stage pneumonectomy had not meet with success. In 1910, Kummel realised a pneumonectomy for lung cancer by clamping the pedicle and leaving the clamps in situ; the patient eventually died on the 6th operative day. The first individual hilar ligation was achieved by Hinz in 1922, and that patient succumbed to heart failure on day 3. Churchill in 1930, Archibald in 1931, and Ivanissevich in 1933 also attempted removal of a whole lung with no survivor beyond a few days. The first successful left-sided pneumonectomy as a two-stage procedure has been performed in Europe by Rudolf Nissen in 1930 in Berlin. In 1933, Graham and Singer reported the first successful en bloc left pneumonectomy, for lung cancer, followed by Overholt who reported the first successful en bloc right pneumonectomy in a patient with a carcinoid tumour in 1935 [1]. Since then, much has been written about the technique, risks, and indications of pneumonectomy, along with the development of our speciality. Obviously, thoracic surgery made great strides with endotracheal mechanical ventilation. The possibility of excluding the ventilation of the operated side was offered from 1935 by Magill. Carlens introduced the first double lumen tube for thoracic surgery in 1950. It needed to wait for the 1970s so that a new technological overhang transforms the daily surgical practice with the invention of surgical staplers, developed during the previous decade by soviet researchers. Finally, the advent of video-assisted surgery and the development of minimally invasive approaches end temporarily this chapter of the technological advances. At the same time, as a better knowledge of cardiac and respiratory physiology was acquired, more and more sophisticated methods of evaluation were developed and provided reasonable guidelines for the relative risk of patient presenting for various sized pulmonary resection and for pneumonectomy. Furthermore, indications for pneumonectomy changed over time. Nowadays, the epidemic development of lung cancer makes the first application of it. Indeed, pneumonectomy for inflammatory lung disease, bronchiectasis, tuberculosis, and other non-malignant conditions is quite uncommon in modern-days medicine. With the advent of lung transplantation, the thoracic surgeon even learnt to replace the removed lung in selected cases. However, despite many efforts, pneumonectomy remains a challenging operation, carrying many complications and anatomic and physiologic changes.