title: Bilateral bronchioloalveolar lung carcinoma: is there a place for palliative pneumonectomy?
abstract: OBJECTIVE
  Bronchioloalveolar lung carcinoma (BAC) is characterized by bronchial and lymphatic dissemination explaining multifocal and bilateral spreading. Bilateral BAC is usually considered as a contraindication to surgery. Regarding poor efficacy of symptomatic and oncological treatments, we hypothesized that surgery might play a role to palliate hypoxemia associated with serious intrapulmonary shunting, as well as continuous bronchorrhea.
  
  
  METHODS
  We retrospectively studied here four consecutive patients, who underwent palliative pneumonectomy.
  
  
  RESULTS
  The shunt was confirmed again at the time of the surgery by a pulmonary artery occlusion demonstrating immediate improvement in arterial oxygen saturation from 89% at baseline to 98% after occlusion. Lung resections consisted of a left pneumonectomy in three cases and a right pneumonectomy in one. PaO(2) levels under 5l/min oxygen therapy improved dramatically when comparing preoperative data (mean 50.5 mmHg) to post-operative results (mean 150 mmHg). One patient died postoperatively. Three patients, who experienced an uneventful immediate post-operative course, received chemotherapy after surgery. Improvement of quality of life is testified by the absence of both symptoms and any need for oxygen therapy for few months. Disabling symptoms reappeared at 1, 8 and 10 months. Survival of these patients was 3, 12 and 18 months.
  
  
  CONCLUSIONS
  These results support the interest of consideration of a surgical resection for highly selected patients presenting with bilateral BAC and severe intrapulmonary shunting.
authors.affiliation: Department of Thoracic Oncology, Sainte-Marguerite Hospital, Marseille, France. fbarlesi@mail.ap-hm.fr
authors.forename: F
authors.initials: F
authors.lastname: Barlesi
authors.forename: C
authors.initials: C
authors.lastname: Doddoli
authors.forename: P
authors.initials: P
authors.lastname: Thomas
authors.forename: J P
authors.initials: JP
authors.lastname: Kleisbauer
authors.forename: R
authors.initials: R
authors.lastname: Giudicelli
authors.forename: P
authors.initials: P
authors.lastname: Fuentes
mesh_terms: D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000098:blood supply / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011013:Pneumonectomy; D012189:Retrospective Studies; D016896:Treatment Outcome