The management of localized, metachronous, primary non-small cell lung cancer (MP-NSCLC) in pneumonectomized patients is challenging. It generally consists in stereotactic radiation therapy. We report the case of a 57-year-old patient who had a prior history of left pneumonectomy and mediastinal irradiation to manage a central stage IIIA NSCLC. He developed a MP-NSCLC in the middle lobe after 6 years. Stereotactic radiation was judged too risky because of the cumulative dose to the heart and risk of pneumonitis. Pulmonary functions and the cardiovascular evaluation were normal. Multidisciplinary discussions suggested a local treatment for this lesion. The patient underwent a thoracoscopic middle lobe lateral segmentectomy on veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. The patient was extubated and weaned from the ECMO at the end of the case and stayed 24 h at the intensive care unit for surveillance. He was discharged from the hospital on day 4. The histopathological analysis revealed a moderately differentiated NSCLC that was completely resected with no lymph node invasion (pT1N0L0V0Pn0R0). Twenty-four months after surgery, the patient is alive and disease free. Management of MP-NSCLC in pneumonectomized patients is challenging and should be tailored to each individual case. Extracorporeal life support has helped push the boundaries of patient operability thus extending survival for patients that could previously not be considered for surgery.