Iterative surgical resections for second primary and local recurrent lung cancer; comparison of lobectomy and limited resection

During a 24-year period (1986-2009), 74 patients (3.5%) underwent iterative surgical resections for 2nd primary and recurrent lung cancer. Patients are classified to 5 groups: 20 2nd primary lung cancer patients undergoing lobectomy (A), 24 2nd primary lung cancer patients undergoing limited resection (B), 11 2nd primary bronchioloalveolar carcinoma (BAC) patients undergoing limited resection (C), 8 recurrent lung cancer patients undergoing lobectomy (D), and 11 recurrent lung cancer patients undergoing limited resection (E). There were 13 (65%) patients with pathological stage IA in group A, 20 (83%) in B, 11 (100%) in C, 2 (25%) in D, and 8 (73%) in E. There were 18 (90%) patients with adenocarcinoma in group A, 15 (63%) in B, 11 (100%) in C, 5 (63%) in D, and 9 (82%) in E. Overall hospital mortality was 5%, including 3 deaths in A and 1 death in D. Five-year and 10-year survival after the 2nd surgery was 55% and 55% in A, 63% and 50% in B, 100% and 100% in C, 57% and 37% in D, and 70% and 53% in E. These data showed that limited resections had low surgical risk and good long-term results. Limited resection appears to achieve better outcomes for 2nd primary and recurrent lung cancer and should be chosen whenever possible.