Multiple primary cancers in surgically resected lung cancer patients

Among 337 cases of surgically resected lung cancer from April 1977 to March 1984, there were 24 cases (7.12%) of multiple primary cancers including 22 cases of double cancer and one case each of triple and quadruple cancer. They consisted of 17 males and 7 females and the patient age at the time of the lung resection ranged from 32 to 81 years old (average: 67.4). In double cancer cases, the most common site of the other primary cancer was the lung (9 cases), followed by the stomach (5 cases), the colon (4 cases), the pancreas (2 cases), and there was one case each of the salivary gland and the skin. The cases of triple and quadruple cancer involved multiple primary lung cancer associated with mammary and esophageal cancer, respectively. There were 14 synchronous and 8 metachronous cases. The histology of lung cancer in 13 cases of double cancer was adenocarcinoma in 6, squamous cell carcinoma in 2, large cell carcinoma in 3, small cell carcinoma in 1, and adenosquamous cell carcinoma in 1. The histology of 11 cases of double or triple primary lung cancers was squamous cell carcinoma in 17, adenocarcinoma in 5, and large cell carcinoma in 1. In 24 cases 19 lobectomies, 4 pneumonectomies and one partial resection of the lung was performed for the first primary lung cancer. All cancer lesions of other organs apart from the lung were also surgically resected.(ABSTRACT TRUNCATED AT 250 WORDS)     

Bronchopleural fistulas developing after pulmonary resections for lung cancer predisposing factors, management, and prognosis

During the past 28 years, 55 bronchopleural fistulas (BPFs) have developed after pulmonary resections for 52 primary and 3 recurrent lung cancers at the National Cancer Center Hospital, Tokyo. During the same period, there were 2446 pulmonary resections for primary lung cancer, the incidence of BPF being 2.1%. As an operative mode of initial resections, pneumonectomy (26 cases) was most common, followed by lobectomy (20 cases), bronchoplasty (8 cases), and stump resection for recurrence (1 case). The following predisposing risk factors for BPF development were identified: resection for locally advanced lung cancer (80.8%); residual carcinomatous tissue at the resected end of bronchus or anastomosis line (29.1%); hypoalbuminemia, diabetes, or steroid administration (20%); pre- and postoperative adjuvant therapy (49.1%). Seven cases received no treatment for BPF because of sudden deaths by massive airway bleeding (5 cases), worsening pneumonia (1 case), and spontaneous recovery (1 case). Remaining 48 cases underwent treatment; tube thoracostomy only in 7 cases and surgical interventions in 41 cases, one case of which was lost during rethoracotomy due to vascular rupture. Initial surgical interventions were composed of combinations of the following procedures; direct re-suture of fistula (16 cases); amputation of the stump and re-closure (3 cases); completion pneumonectomy (6 cases); reinforcement and wrapping of fistula (27 cases); thoracoplasty (29 case). Among these 40 surgical repairs, fistula was successfully closed in 11 cases. In 5 cases, the fistula closure could be achieved after subsequent surgical procedures. Direct re-suture was successful only in 4 cases. In spite of various kinds of treatment, overall prognosis was quite poor; 37 cases died of BPF-related complications (67.3% mortality).(ABSTRACT TRUNCATED AT 250 WORDS)     

Second surgical intervention for contralateral recurrence or second primary lung cancer

Resection of contralateral lung cancer (6 cases of pulmonary metastasis from the first lung cancer and one case of second primary lung cancer) were evaluated retrospectively in terms of postoperative complication, pulmonary function and survival rate. Out of 691 cases with resected non small cell lung cancer, 7 cases (1.0%) had contralateral lung cancer which were resected as the second operation. Six cases were squamous cell carcinoma and one case was adenocarcinoma. The interval between the first and the second operation was 12 months to 10 years (average 46 months). The post-operative stage of first lung cancer were stage I in 5 cases and stage IIIB in 2 cases, but no case had lymphadenopathy at the first operation. Operative procedures for contralateral lung were as follows; one case of lobectomy----lobectomy, one case of lobectomy----segmentectomy, two cases of lobectomy----partial resection, two cases of pneumonectomy----partial resection. For a metachronous lung cancer, right upper sleeve lobectomy was done as the first operation followed by left lower sleeve lobectomy as the second cancer five years later. Contralateral lung resection impaired pulmonary function, but all cases well tolerated the second operation. The five-years survival rate after second operation was 40.0%.     

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.     

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.     

Study on cases of resected primary lung cancer in young persons]

A clinical study was conducted of 17 patients aged less than 40 years who received resection for lung cancer in our department. The 17 cases made up 1.8% of the total series of 924 resected lung cancer cases, with the number of cases increasing as the age of 40 years was approached. The male-female ratio was 1.1:1, with proportion of women higher than in the total series of lung cancer cases. The histological type of included a high proportion of adenocarcinomas (47.0%), while squamous cell carcinomas were few. In addition, the proportion of tumors of low-grade malignancy such as carcinoid tumors and mucoepidermoid carcinomas was high. The majority (58.8%) of cases were detected by mass screening. As a result, the number of stage I cases was high (10 cases, 58.8%), and curative resection could be performed in 70.8%. The prognosis of these young patients did not differ significantly from that of the total resected group, with a 5-year survival rate of 62.4% achieved. It was considered that the prognosis of lung cancer in young persons can also be improved with early detection by mass screening and active surgical intervention.     

Peripherally located occult lung cancer with AMFR expression.

A 67-year-old man was referred to our hospital because of positive sputum cytology. Despite detailed examination, the malignant cell source remained elusive. Twenty months later, CT revealed two nodules in the right S1 and S10 regions which were resected. A year following the operation, gastoendoscopy showed a stomach tumor. Total gastrectomy with lymph node dissection was performed. Histologically, this patient was diagnosed with double primary lung cancer with metastasis to the stomach. The tumors of the lung, stomach and tumor cells in the sputum showed the same immunoreactivities of autocrine motility factor receptor (AMFR). In our institution, of 38 occult lung cancers encountered during the past 10 years, four (10.5%) occurred in the peripheral region. The presented four cases of radiologically occult lung cancer in the peripheral resion revealed bad prognosis, as three out of four patients were dead within 24 months after surgery. All of the four cases showed venous invasion, though the size of the primary tumor was small. Careful follow-up, including monitoring for distant metastasis, is necessary in radiologically occult peripheral lung cancer.     

Prognosis of patients after resection for lung cancer with intrapulmonary metastasis in different lobes

BACKGROUND: The prognosis of lung cancer patients with intrapulmonary metastasis in different lobes (pm2) is poor. However, some patients achieve long-term survival. We retrospectively investigated the prognosis of resected primary lung cancer patients with pm2. METHOD: Among 845 patients with primary lung cancer who underwent complete resection from 1984 to 2003, 14 cases that had lung cancer with pm2 were evaluated about prognostic factors. RESULTS: The overall 5-year survival rate was 9.5%. The analysis of survival curve based on clinicopathological factors (surgical procedure, histology, tumor size, lymph nodal metastasis, pleural invasion, pleural dissemination and number of pm2) revealed that bronchioloalveolar carcinoma (BAC), the absence of pleural invasion and the absence of pleural dissemination are better prognostic factors. CONCLUSION: Lung cancer patients with pm2 whose lesions show BAC histology, the absence of pleural invasion or pleural dissemination may achieve long-term survival and could be candidates for surgical treatment.     

The management of second primary lung cancers. A single centre experience in 15 years.

OBJECTIVE: In patients treated for an initial lung cancer, the cumulative risk of developing a second primary lung cancer is a recognised occurrence. This study reviews our experience in the clinical assessment and surgical management of second primary lung cancer (SPLC). METHODS: Between 1985-1999 a series of 892 patients with primary carcinoma of lung underwent surgical resection with curative intent in our institution. Using criteria set out by Martini and Melamed (J Thorac Cardiovasc Surg 70 (1975) 606) we were able to identify 51 patients who had developed a SPLC identified as the first site of re-occurrence. RESULTS: Forty-one patients developed a metachronous SPLC within a mean of 46+/-14 months of the first operation while ten patients had synchronous double lung cancer (six unilateral, four bilateral). The cumulative probability of cancer free interval for metachronous cancers was 39% at 3 years, 15% at 5 years and 2% at 10 years. There were three postoperative deaths among the metachronous cancers (7.5%) and there were no operative deaths among patients with synchronous cancers. The overall actuarial 5-year survival for all patients with SPLC was 38% with a median survival of 40 months (range 1-142 months). The actuarial 5-year survival for metachronous SPLC was 44%, median survival of 49 months (range 1-142 months), while the actuarial 5-years survival for synchronous SLPC was 10% with a median survival of 31 months (range 4-78 months). CONCLUSION: Aggressive assessment and surgical intervention is safe, effective and warranted in patients with a second lung primary cancer if they satisfy the usual criteria of operability after full assessment. This is true for patients with metachronous cancers, while patients with synchronous cancers tend to have worse prognosis. A long term follow-up policy after the initial resection of the primary lung cancer is recommended at intervals of 6 months for at least 3-5 years and then annually to enable the early detection of the second cancer.     

Completion pneumonectomy--a review of 29 cases

From 1962 through 1988, a total of 29 consecutive patients had completion pneumonectomy (CP). Indications for initial pulmonary resection were primary lung cancer in 27 patients, metastatic lung tumor in 1, and mediastinal tumor with pulmonary invasion in 1. Indications for CP were lung cancer (including local recurrence, pulmonary metastasis from the first lung cancer, and second primary lung cancer) in 21 patients, complications after initial operations in 7, and pulmonary arterial injury during second operation in 1. Severe adhesion of the residual lung and the hilar structures made operative procedures extremely difficult. Injury of pulmonary arteries occurred in 6 patients. Especially, in cases the left upper lobe had been resected previously, deviation of the lower lobe and hilar adhesion lead to operative difficulty. Post-CP bronchial fistula occurred more frequently in what the bronchi had been dissected at more peripheral level than main bronchus, because of some severe hilar adhesions. Operative mortality was 13.8% (9.5% for second lung cancer, 28.5% for post-operative complication). Five-year survival for patients with lung cancer was 32.9% according to the Kaplan-Meier method. We conclude that the indications for CP are clinically resectable lung cancer and bronchial stenosis with residual pulmonary organic changes following bronhoplastic procedure. Postoperative bronchofistulae should be managed by other operative procedure.     

Surgical treatment for metastatic lung tumors with incidentally coexisting lung cancer.

We report four surgically resected cases of a metastatic lung tumors with incidentally coexisting lung cancer. Two patients (Cases 1 and 2) were admitted for surgical treatment for pulmonary metastases from colon cancer, and the other two (Cases 3 and 4) were for pulmonary metastases from renal cell carcinoma. In only one patient (Case 3), one lesion among the multiple shadows on the preoperative computed tomography examination was rather strongly suspected to be primary lung cancer. In three patients (Cases 1, 2 and 3), one of the resected lesions in each individual case was diagnosed as lung adenocarcinoma by an intraoperative examination using frozen sections, and was later histologically confirmed. In Case 4, one of the resected lesions was postoperatively determined to be lung adenocarcinoma. All coexisting lung cancers, treated with partial resection of the lung, were well-differentiated small-sized adenocarcinoma (T1N0), while the other lesions resected in each case were metastases from the individual cancer. Problems in preoperative diagnosis and surgical treatment for metastatic lung tumors with incidentally coexisting lung cancer are discussed.     

Surgical treatment for metastatic lung tumors with incidentally coexisting lung cancer

We report four surgically resected cases of a metastatic lung tumors with incidentally coexisting lung cancer. Two patients (Cases 1 and 2) were admitted for surgical treatment for pulmonary metastases from colon cancer, and the other two (Cases 3 and 4) were for pulmonary metastases from renal cell carcinoma. In only one patient (Case 3), one lesion among the multiple shadows on the preoperative computed tomography examination was rather strongly suspected to be primary lung cancer. In three patients (Cases 1, 2 and 3), one of the resected lesions in each individual case was diagnosed as lung adenocarcinoma by an intraoperative examination using frozen sections, and was later histologically confirmed. In Case 4, one of the resected lesions was postoperatively determined to be lung adenocarcinoma. All coexisting lung cancers, treated with partial resection of the lung, were well-differentiated small-sized adenocarcinoma (T1N0), while the other lesions resected in each case were metastases from the individual cancer. Problems in preoperative diagnosis and surgical treatment for metastatic lung tumors with incidentally coexisting lung cancer are discussed.     

Assessment of prognosis and p 53 mutations in patients with multiple tumors of the lung; intrapulmonary metastasis or double primary cancers?]

To assess whether a satellite lesion in the primary-tumor lobe is intrapulmonary metastasis from primary cancer (pm 1) or they are double primary lung cancers, we examined the postoperative prognosis of patients with pm 1 and the p 53 genetic differentiation between a satellite lesion and a primary lesion. Of 772 consecutive patients with N0-2M0 non-small cell lung cancer who underwent surgical resections between 1979 and 2000, 31 patients had a satellite lesion in the primary-tumor lobe. The 5-year survival rate was 26.3% in the pm 1 (+) T 4 group (n = 37), 14.7% in the pm 1 (-) T 4 group (n = 43), and 32.5% in the T 3 group (n = 132), suggesting that pm 1 cases should be classified as T 3. We examined 16 of 37 patients with pm 1 for mutations of the p 53 gene occurring exons 5 through 8 by the fluorescence-based polymerase chain reaction single-strand conformation polymorphism. Seven of the 16 patients analyzed had at least one p 53 mutations in their tumors. The mutational status of the p 53 gene was discordant in 5 patients, suggesting they were double primary lung cancers. The mutational status including DNA sequencing of the p 53 gene was concordant in 2 patients, suggesting they were intrapulmonary metastases. It remains arguable in the TNM staging system whether a satellite lesion in the primary-tumor lobe is intrapulmonary metastasis from primary cancer or they are double primary lung cancers.     

Prognostic elements in bronchial carcinoma]

In spite of improvements in diagnosis and treatment, the fatal prognosis of lung cancer has persisted over the course of 25 years in a series of nearly 4000 patients. Only 30% (1149 cases) were operable, and on 23% of those resected (i.e. 7% of the total) survived for 5 years. An assessment is made of the relationship between survival and sex, age, tumour size and site, radiological picture, stage of invasiveness, type of surgery and degree of radicality, histological picture, and number of circulating lymphocytes. Age, sex and the type of resection (lobectomy or pneumonectomy) had no relation to prognosis. Palliative surgery was always associated with a fatal prognosis, as were cases with invasion of the chest wall, or, more particularly, with oat cell cancers. The outlook was more favourable in cases where radical treatment was given, in cases of squamous cancer, as opposed to other histological types, in those in stage 1 (Am. Joint Committee classification), and those with greater than 2000/mm3 lymphocytes--especially in adenocarcinomas.     

Hematoporphyrin derivative and photoradiation therapy in early stage lung cancer

Photoradiation therapy (PRT) with administration of hematoporphyrin derivative (HPD) was performed in ten cases of early stage central-type lung cancer of which six cases were treated by PRT alone due to inoperability because of poor pulmonary function in five and refusal of surgery in one. Four cases were resected after PRT. In the former, complete tumor remission was obtained in all six and in the latter, complete tumor remission was seen in one and significant remission in three. In the nonresected cases four cases are disease-free at 17-41 months and the remaining two cases died of chronic obstructive lung disease and cerebral infarction 16 and 31 months after PRT, respectively. The resected cases are disease-free 7-32 months after surgery. Indications of PRT in early stage lung cancer are discussed according to histological findings of resected specimen.     

Double cancer observed from bladder cancer]

BACKGROUND: In recent years, despite of the improvement of treatment results for cancer and long life, the occurrence of second primary cancer was increased. In this paper, we analyzed present condition of double cancer observed with bladder cancer in our hospital. METHOD: Last 21 years, we have treated 969 cases (828 male and 141 female) of primary bladder cancer. For those cases, we analyzed in term of frequency, involved organ, age, interval between two cancer occurrence, risk factor and prognosis of double cancer patients. RESULT: Of 969 cases with bladder cancer, 81 cases (8.36%) had double cancer involving 6 cases (0.61%) of triple cancer. In sex, 70 males (9.78%) and 11 females (7.80%) had double cancer. As involved organs, 25 cases (3.02%) had in prostate, 23 cases (2.37%) in stomach, 3 case (2.13%) in breast, 14 cases (1.44%) in colon and rectum. In diagnosis timing of complicated cancer from bladder cancer, 28 cases (34.6%) were diagnosed previously to bladder, 28 cases (34.6%) were simultaneously and 31 cases (38.3%) were secondary. An average interval of diagnosis of two cancer were 49 +/- 42.5 months. An average age of occurrence of second cancer was 70.3 +/- 8.8 years. Actual survival rate from diagnosis of bladder cancer were 90.8%, 68.6%, 53.3% and 30.3%, after 1, 3, 5 and 10 years, respectively. Ten cases were dead by bladder cancer, 21 cases by complicated cancer and 16 cases by another cause. CONCLUSION: The incidence of double cancer with bladder cancer were increased. Prostate cancer, colorectal cancer and breast cancer were gradually increased as complicated organs in Japan. The prognosis of double cancer patients with bladder cancer was poor than single bladder cancer patients.     

Combined surgery for cardiovascular disease and general thoracic lesions

Surgical management of patients with concomitant critical cardiovascular disease and resectable general thoracic lesions is controversial. During a 16-year period (1985 to 2001), 15 patients underwent combined cardiovascular and general thoracic operations, of the 2,459 patients who underwent a cardiovascular operation requiring cardiopulmonary bypass at our institution. Patients had cardiovascular symptoms only and the general thoracic lesions were incidentally found by preoperative chest roentgenograms and/or computed tomography. Because of the cardiovascular disease, a pathological diagnosis was precluded before surgery. All except one descending thoracic aortic operation underwent concurrent pulmonary resection after neutralization of protamine following cardiovascular surgery requiring extracorporeal circulation. Lung pathology consisted of pulmonary bullae (n = 7), primary lung cancer (n = 4), benign lung tumor (n = 2), metastatic lung cancer (n = 1), and thymic cyst (n = 1). The pulmonary operations include bullectomy (n = 7), wedge resection (n = 6), lobectomy (n = 3), and removal of a thymic cyst (n = 1) including 2 staged procedures. The final diagnoses in 4 lung cancer cases were T1. N0M0, stage IA (n = 3) and T2N2M0, stage IIIA (n = 1). All malignancies including metastatic lung cancer, were able to be completely resected. The mean intraoperative bleeding volume for the cases was 997 +/- 221 ml, while mean duration of surgery was 382 +/- 31 minutes. Except for 2 cases required long term ventilatory support, the mean durations of tracheal intubation and ICU stay were 2.2 +/- 0.2 and 3.8 +/- 1.0 days respectively. Except for 1 surgical death, mean survival duration and 5-year survival rate were 59.7 +/- 12.5 (5-177) months and 66.3% respectively. These findings suggest that combined pulmonary resection with cardiovascular surgery is safe and offers a favorable prognosis to a selected group of patients.