Second surgical intervention for recurrent and second primary bronchogenic carcinomas.

Second operations were performed in 1961-1990 on 23 patients with non-small cell bronchogenic carcinoma, constituting 2.5% of 906 who had undergone pulmonary resection for such tumor and 3.6% of the 641 with apparently curative surgery. The second operation was performed for recurrent tumor in 15 cases and for second primary tumor in eight. Five-year survival after the first operation was 30% in the former group and 88% in the latter (significant difference). Among the total 23 patients, this survival rate was 51%. The study indicates that an aggressive attitude to second surgical intervention is warranted. For early detection of second lesions, follow-up at maximally 6-month intervals should be continued for more than 5 years after the first operation.     

Completion pneumonectomy for recurrent or second primary lung cancer

OBJECTIVE: We studied 8 patients undergoing completion pneumonectomy for recurrent or second primary lung cancer. METHODS: Subjects were men who averaged 62 years of age. Of these 6 had p-stage I, and 2 p-stage II disease at initial operation. At the second operation, we diagnosed 3 with second primary lung cancer and 5 with recurrent lung cancer. We predicted postoperative pulmonary function by calculating the predicted forced expiratory volume in 1.0 second (FEV1.0) from residual numbers of subsegments after completion pneumonectomy. All predicted FEV1.0 in our 8 cases ranged from 544 to 926 (773 +/- 144) ml/m2. RESULTS: Six patients experienced postoperative complications and morbidity was 75%. One patient undergoing completion sleeve pneumonectomy after radiation therapy for local carina recurrence died on 7th postoperative day due to anastomotic dehiscence and pneumonia. Overall operative mortality was 12.5% (1/8). Four remain alive and actuarial 5-year survival was 37.5%. CONCLUSIONS: Careful consideration is needed in determining operative indications for completion pneumonectomy for patients after radiation therapy. Patients with recurrent squamous cell carcinoma who have p-stage I disease at initial operation and those with second primary lung cancer and p-stage I or II disease can expect relatively a long-term survival, and we concluded that completion pneumonectomy could be conducted in these cases with a satisfactory prognosis.     

Surgery for intrathoracic recurrence and second primary tumors in resected lung cancer

From 1986 to 2000, 42 patients (3.7%) underwent resection for intrathoracic recurrence or second primary lung cancer. Survival in 27 patients with recurrent diseases was 60% at 5 years and 35% at 10 years compared with 65% at 5 and 10 years for 15 patients with metachronous lung cancers morphologically. Ten patients had the second operation less than 2 years since the first operation, 19 patients between 2 and 5 years, and 13 patients more than 5 years, while these 5-year survivals were 72%, 53%, 67% respectively. At the first operation lobectomy was performed in 39 patients (93%), wedge resection or segmentectomy in 3. The reoperation was 14 lobectomy or completion pneumonectomy, 24 wedge or segmentectomy (57%), and 4 other procedures, while these 5-year survivals were 35%, 73%, and 100% respectively. The 5-year survival was 78% for 27 patients with stage I disease and 26% for 10 patients with stage III disease at the first operation, compared with 55% for 30 patients with stage I and 53% for 9 patients with stage III at the reoperation. These data suggest that limited resection is recommended for intrathoracic recurrent diseases and metachronous multiple lung cancers whenever possible.     

异时第二原发肺癌的诊断及手术治疗

目的 探讨异时第二原发肺癌的诊断、手术治疗方式和预后。方法 对我院胸外科自1983年1月至2004年4月手术治疗的32例异时第二原发肺癌患者的临床资料进行回顾性分析。结果 15例有咳嗽、痰血、气短等症状,17例随诊中经影像学检查发现。第一原发肺癌均行肺叶切除或全肺切除。异时第二原发肺癌行肺叶切除或完成式全肺切除17例,局部切除14例,单纯探查1例;15例行淋巴结清扫,17例未清扫淋巴结;6例为姑息性切除。手术切除率和根治切除率分别为97％(31／32)和81％(26／32)。两次手术为同侧者17例(9例为右侧)。组织学类型：鳞癌11例,腺癌7例,腺鳞癌6例,肺泡细胞癌5例,小细胞肺癌、小细胞并鳞癌及腺样囊性癌各1例;第一、二原发肺癌组织学类型不同者24例,组织学类型相同但发现的时间间隔超过4年者7例。术后临床病理分期：Ⅰa期4例,Ⅰb期16例,Ⅱa期1例,Ⅱb期4例,Ⅲa期1例,Ⅲb期5例,左肺上下叶各有一Ⅰa期癌灶者1例。术后并发症发生率、手术死亡率分别为12％(4／32),3％(1／32),并发症为支气管胸膜瘘、心房纤颤和呼吸功能不全,死亡原因为呼吸衰竭;术后1,3,5年生存率分别为660k,(19／29),32％(9／28),19％(4／21)。结论 加强术后随诊和提高鉴别诊断能力是提高第二原发肺癌诊断率的关键。手术切除方式受限和淋巴结清扫不彻底可能是患者预后不佳的原因之一。     

Effective follow-up for recurrence or a second primary cancer in patients with early gastric cancer

BACKGROUND: Patients with early gastric cancer have an excellent prognosis with low rates of recurrence, but may have an increased risk of developing a second primary cancer. Because the number of early gastric cancers has increased, clarification of both recurrences and second primary cancers is important for the development of effective postoperative follow-up programmes. METHODS: Data on 1070 patients with early gastric cancer were analysed retrospectively with respect to the clinicopathological features of both recurrence and second primary cancers after surgical treatment. RESULTS: Multivariate analysis showed that lymph node metastasis and older age were independent risk factors for recurrence of early gastric cancer. The incidence of second primary cancers was 5.0 per cent; lung and colorectal cancers were detected most frequently, followed by cancers in the oesophagus, breast and remnant stomach. CONCLUSION: Clinicopathological features of patients with early gastric cancer can be used to identify those most at risk of developing either recurrence or a second primary cancer.     

Surgical treatment and outcome for postoperative recurrent or second primary lung cancer

From 2000 to 2009, we retrospectively reviewed 62 patients who underwent surgical treatment for postoperative recurrent or 2nd primary lung cancer. Of the 62 patients, 43 were men and 19 were women with an average age of 67.6 years old. The histology of the initial primary lung cancer was adenocarcinoma in 42 patients, squamous cell carcinoma in 18, large cell carcinoma in 1 and small cell carcinoma in 1. The surgical procedures for 1st operation were lobectomy with mediastinal lymph node dissection in 52, bilobectomy with mediastinal lymph node dissection in 4, sleeve lobectomy with mediastinal lymph node dissection in 3, and lobectomy + segmentectomy or wedge resection with mediastinal lymph node dissection in 3. p-stage of the 1st primary lung cancer was IA in 22, IB in 16, II A in 7, IIB in 6, IIIA in 6, IIIB in 4, and IV in 1. On the 2nd operation, 56 patients underwent limited surgery. Five patients underwent a lobectomy twice metachronous bilateral lesions and 1 patient underwent completion pneumonectomy (CP) at the 2nd operation. The average age at 2nd operation was 71.8 years old. Of these, 42 patients were diagnosed 2nd primary lung cancer, 20 patients were recurrent disease histologically. The 5-year survival rate of the patients with metachronous and recurrent disease from the 2nd operation was 54.1%, and 43.1%, respectively. Although lobectomy or CP should be considered the surgical procedure of choice for patients with metachronous lung cancer, with this result, we consider that postoperative good survival can be expected by even the limited operation for cases of postoperative recurrent or 2nd primary lung cancer because of possible early detection. We conclude that limited surgery may be a treatment of choice for recurrent or 2nd primary lung cancer after initial operation.     

Surgical results for second primary lung cancer

Of 897 patients who underwent operation for lung cancer between April 1996 and March 2010, 57 patients underwent pulmonary resection for 2nd primary lung cancer. There were 44 men and 13 women. The average age at the 2nd operation was 71. The initial pulmonary resection was lobectomy in 49 patients, segmentectomy in 4 and wedge resection in 4. The 2nd pulmonary resection was lobectomy in 10 patients, segmentectomy in 12 and wedge resection in 35. Preoperative stage of the 2nd primary lung cancer was IA in 43, IB in 13 and IIB in 1. Postoperative stage was IA in 38, IB in 10, IIA in 1, IIB in 3, IIIA in 2 and IIIB in 3. Surgical complications occurred in 4, but there were no perioperative deaths. The 5-year survival rate for 2nd primary lung cancers was 59.9%. The 5-year survival rate for patients treated with wedge resection was 71.1%. The 5-year survival rate of the patients with p-stage IA was 72.7%, and that for patients with p-stage IB or more advanced diseases was 32.9%. We conclude that an aggressive surgical approach for a 2nd primary lung cancer is effective and is linked with good outcome if the tumor is detected at stage IA, when the possible cure by performing wedge resection is promissing.     

Surgical treatment for recurrent and second primary lung cancer

We analyzed 39 patients who underwent a 2nd resection for recurrent (solitary pulmonary metastasis) or 2nd primary lung cancer. Based on the pathological findings, 18 patients were diagnosed as recurrent lung cancer, and 21 patients were diagnosed as 2nd primary lung cancer. Overall 5-year survival was 69.4%. There are no difference between recurrent group and 2nd primary group. It is difficult to distinguish preoperatively between recurrent lung cancer and 2nd primary lung cancer, so we must be consider the 2nd resection as a curative resection for "2nd primary lung cancer".     

Curative resection of both primary and second primary lung cancer

Curative resection of a second primary lung cancer in a patient who survived small-cell lung cancer is reported. Small-cell cancer had been treated with chemotherapy followed by surgical resection 12 years before. The patient developed squamous cell cancer as the second primary tumor and underwent lobectomy with mediastinal node dissection. Patients who undergo two curative pulmonary resections of both primary and second primary lung cancer are extremely rare. The patient is alive 176 months after the initial diagnosis of small-cell lung cancer and 28 months after resection for his second primary lung cancer. Careful follow-up at an interval of 3-6 months beyond 10 years is very important because adequate treatments could lead to longer survival of patients with primary small-cell lung cancer.     

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.     

双原发肺癌外科治疗的疗效分析

目的 探讨双原发肺癌的外科治疗结局和长期生存率.方法 对1999年1月至2009年6月收治的98例双原发肺癌患者的临床资料进行回顾性分析.同时双原发肺癌患者共72例,其中男性54例,女性18例;发病中位年龄66岁.异时双原发肺癌患者26例,其中男性20例,女性6例;第一原发癌发病中位年龄59.5岁,第二原发癌发病中位年龄66岁.同时双原发肺癌患者72例,144个肿瘤病灶,手术方式包括肺叶切除9例,双肺叶切除14例,全肺切除6例,肺叶切除并楔形切除33例,双楔形切除9例,双肺叶切除并楔形切除1例;异时双原发肺癌患者26例,52个肿瘤病灶,手术方式包括肺叶切除31次,双肺叶切除1次,楔形切除10次,全肺切除8次.结果 全组患者术后30 d病死率为0,术后并发症发生率为13.3%.全组患者从术后开始随访至2009年12月,随访率＞90%.全组患者从发现第一原发癌开始计算,其5年生存率为66.4%.异时第一原发肺癌和同时双原发肺癌的5年生存率差异有统计学意义(96.2%比43.0%,P=0.000).异时第二原发肺癌和同时双原发肺癌的5年生存率差异无统计学意义(45.9%比43.0%,P=0.634).结论 外科手术治疗双原发肺癌是合理的,能使患者获得较高的长期生存预期.     

双原发肺癌外科治疗的疗效分析

目的 探讨双原发肺癌的外科治疗结局和长期生存率.方法 对1999年1月至2009年6月收治的98例双原发肺癌患者的临床资料进行回顾性分析.同时双原发肺癌患者共72例,其中男性54例,女性18例;发病中位年龄66岁.异时双原发肺癌患者26例,其中男性20例,女性6例;第一原发癌发病中位年龄59.5岁,第二原发癌发病中位年龄66岁.同时双原发肺癌患者72例,144个肿瘤病灶,手术方式包括肺叶切除9例,双肺叶切除14例,全肺切除6例,肺叶切除并楔形切除33例,双楔形切除9例,双肺叶切除并楔形切除1例;异时双原发肺癌患者26例,52个肿瘤病灶,手术方式包括肺叶切除31次,双肺叶切除1次,楔形切除10次,全肺切除8次.结果 全组患者术后30 d病死率为0,术后并发症发生率为13.3%.全组患者从术后开始随访至2009年12月,随访率＞90%.全组患者从发现第一原发癌开始计算,其5年生存率为66.4%.异时第一原发肺癌和同时双原发肺癌的5年生存率差异有统计学意义(96.2%比43.0%,P=0.000).异时第二原发肺癌和同时双原发肺癌的5年生存率差异无统计学意义(45.9%比43.0%,P=0.634).结论 外科手术治疗双原发肺癌是合理的,能使患者获得较高的长期生存预期.     

双原发肺癌外科治疗的疗效分析

目的 探讨双原发肺癌的外科治疗结局和长期生存率.方法 对1999年1月至2009年6月收治的98例双原发肺癌患者的临床资料进行回顾性分析.同时双原发肺癌患者共72例,其中男性54例,女性18例;发病中位年龄66岁.异时双原发肺癌患者26例,其中男性20例,女性6例;第一原发癌发病中位年龄59.5岁,第二原发癌发病中位年龄66岁.同时双原发肺癌患者72例,144个肿瘤病灶,手术方式包括肺叶切除9例,双肺叶切除14例,全肺切除6例,肺叶切除并楔形切除33例,双楔形切除9例,双肺叶切除并楔形切除1例;异时双原发肺癌患者26例,52个肿瘤病灶,手术方式包括肺叶切除31次,双肺叶切除1次,楔形切除10次,全肺切除8次.结果 全组患者术后30 d病死率为0,术后并发症发生率为13.3%.全组患者从术后开始随访至2009年12月,随访率＞90%.全组患者从发现第一原发癌开始计算,其5年生存率为66.4%.异时第一原发肺癌和同时双原发肺癌的5年生存率差异有统计学意义(96.2%比43.0%,P=0.000).异时第二原发肺癌和同时双原发肺癌的5年生存率差异无统计学意义(45.9%比43.0%,P=0.634).结论 外科手术治疗双原发肺癌是合理的,能使患者获得较高的长期生存预期.     

双原发肺癌外科治疗的疗效分析

目的 探讨双原发肺癌的外科治疗结局和长期生存率.方法 对1999年1月至2009年6月收治的98例双原发肺癌患者的临床资料进行回顾性分析.同时双原发肺癌患者共72例,其中男性54例,女性18例;发病中位年龄66岁.异时双原发肺癌患者26例,其中男性20例,女性6例;第一原发癌发病中位年龄59.5岁,第二原发癌发病中位年龄66岁.同时双原发肺癌患者72例,144个肿瘤病灶,手术方式包括肺叶切除9例,双肺叶切除14例,全肺切除6例,肺叶切除并楔形切除33例,双楔形切除9例,双肺叶切除并楔形切除1例;异时双原发肺癌患者26例,52个肿瘤病灶,手术方式包括肺叶切除31次,双肺叶切除1次,楔形切除10次,全肺切除8次.结果 全组患者术后30 d病死率为0,术后并发症发生率为13.3%.全组患者从术后开始随访至2009年12月,随访率＞90%.全组患者从发现第一原发癌开始计算,其5年生存率为66.4%.异时第一原发肺癌和同时双原发肺癌的5年生存率差异有统计学意义(96.2%比43.0%,P=0.000).异时第二原发肺癌和同时双原发肺癌的5年生存率差异无统计学意义(45.9%比43.0%,P=0.634).结论 外科手术治疗双原发肺癌是合理的,能使患者获得较高的长期生存预期.

Abstract：

Objective To verify the outcome and long-term survival of surgical management for double primary lung cancers. Methods The clinical data of 98 patients with double primary lung cancers admitted between January 1999 and June 2009 was analyzed retrospectively. There were 72 cases of synchronous double primary lung cancers, including 54 males and 18 females with median age of onset of 66 years (37 to 79 years). Thoracic surgical procedures for 144 tumor lesions included lobectomy for 9 cases, bilobectomy for 14 cases, pneumonectomy for 6 cases, lobectomy plus wedge resection for 33 cases, double wedge resection for 9 cases, and bilobectomy plus wedge resection for 1 case. There were 26 cases of metachronous double primary lung cancers, including 20 males and 6 females. The median age for the first primary cancer was 59. 5 years (38 to 73 years) , for second primary cancer was 66 years (47 to 77 years). Thoracic surgical procedures for 52 tumor lesions included lobectomy for 31 cases, bilobectomy for 1 cases, wedge resection for 10 cases, and pneumonectomy for 8 cases. Results The overall 30-day mortality was 0.Postoperative complications rate was 13. 3% . All patients were followed up after the operation. Until December 2009, follow-up rate was over 90%. Five-year survival for all the patients from the time of initial diagnosis of cancer was 66. 4%. Five-year survival for patients with metachronous and synchronous disease from the time of initial diagnosis of cancer was 96. 2% and 43. 0% ( P =0. 000) , respectively. Survival at 5 years for the second cancer of metachronous disease and synchronous disease was 45. 9% and 43. 0% (P =0. 634) ,respectively. Conclusion Surgical treatment for double primary lung cancer is reasonable, and the patients can make long-term survival.     

Surgical outcomes of ipsilateral metachronous second primary lung cancer

 Open in a separate windowOBJECTIVESThe optimal surgical approach for metachronous second primary lung cancer (MSPLC), especially ipsilateral MSPLC, remains unclear. This study aimed to review postoperative complications and examine surgical outcomes based on the extent of resection after surgery for ipsilateral MSPLC.METHODSClinical data from 61 consecutive patients who underwent pulmonary resection for ipsilateral MSPLC according to the Martini–Melamed criteria between January 2005 and December 2017 in 3 institutes were retrospectively reviewed.RESULTSPostoperative complications were identified in 12 patients (19.7%). Regarding the combination of initial and second surgery, intraoperative bleeding was significantly greater in patients with anatomic–anatomic resection than in others (P < 0.001). Operation time was significantly longer in patients with anatomic–anatomic resection than in others (P < 0.001). However, postoperative complications showed no significant differences based on the combination of surgeries. Five-year overall survival rates in patients with anatomic resection and wedge resection after second surgery were 75.8% and 75.8%, respectively (P = 0.738), and 5-year recurrence-free survival rates were 54.2% and 67.6%, respectively (P = 0.368). Cox multivariate analysis identified ever-smoker status (P = 0.029), poor performance status (P = 0.011) and tumour size >20 mm (P = 0.001) as independent predictors of poor overall survival, while ever-smoker status (P = 0.040) and tumour size >20 mm (P = 0.007) were considered independent predictors of poor recurrence-free survival.CONCLUSIONSRegarding postoperative and long-term outcomes for patients with ipsilateral MSPLC, surgical intervention is safe and offers good long-term survival. Wedge resection is an acceptable provided tumours ≤2 cm and ground-glass opacity-predominant as a second surgery for early-stage ipsilateral MSPLC.