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 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.     

Subsequent pulmonary resection for bronchogenic carcinoma after pneumonectomy

BACKGROUND: Patients who have undergone a pneumonectomy for bronchogenic carcinoma are at risk of cancer in the contralateral lung. Little information exists regarding the outcome of subsequent lung operation for lung cancer after pneumonectomy. METHODS: The records of all patients who underwent lung resection after pneumonectomy for lung cancer from January 1980 through July 2001 were reviewed. RESULTS: There were 24 patients (18 men and 6 women). Median age was 64 years (range, 43 to 84 years). Median preoperative forced expiratory volume in 1 second was 1.47 L (range, 0.66 to 2.55 L). Subsequent pulmonary resection was performed 2 to 213 months after pneumonectomy (median, 23 months). Wedge excision was performed in 20 patients, segmentectomy in 3, and lobectomy in 1. Diagnosis was a metachronous lung cancer in 14 patients and metastatic lung cancer in 10. Complications occurred in 11 patients (44.0%), and 2 died (operative mortality, 8.3%). Median hospitalization was 7 days (range, 2 to 72 days). Follow-up was complete in all patients and ranged between 6 and 140 months (median, 37 months). Overall 1-, 3-, and 5-year survivals were 87%, 61%, and 40%, respectively. Five-year survival of patients undergoing resection for a metachronous lung cancer (50%) was better than the survival of patients who underwent resection for metastatic cancer (14%; p = 0.14). Five-year survival after a solitary wedge excision was 46% compared with 25% after a more extensive resection (p = 0.54). CONCLUSIONS: Limited pulmonary resection of the contralateral lung after pneumonectomy is associated with acceptable morbidity and mortality. Long-term survival is possible, especially in patients with a metachronous cancer. Solitary wedge excision is the treatment of choice.     

Intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration

OBJECTIVE: The aim of this study was to assess the adequacy of our intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration. METHODS: Patients who had stage IA non-small cell lung cancer (NSCLC) with a maximum tumor diameter of 2 cm or less were candidates for limited resection. If bronchioloalveolar carcinoma (BAC) was suspected on computed tomography and intraoperative pathologic exploration revealed the lesion as BAC without foci of active fibroblastic proliferation (Noguchi type A and B), wedge resection was performed. If the tumor was not suspected of being Noguchi type A or B, extended segmentectomy with intraoperative lymph node exploration was performed. RESULTS: Limited resection was performed in 34 patients, wedge resection in 14, and extended segmentectomy in 20. The median follow-up period after wedge resection was 36 months, and all patients are alive with no signs of recurrence. The median follow-up period after extended segmentectomy was 54 months. No local recurrences were found, but distant metastasis was diagnosed in one patient. The 5-year survival rate after extended segmentectomy was 93%. In the same period, lobectomy was performed in 57 patients with stage IA NSCLC with a maximum tumor diameter of 2 cm or less, and the 5-year survival rate was 84%. There were no significant differences in 5-year survival between extended segmentectomy and lobectomy. CONCLUSIONS: Careful selection of patients based on high-resolution computed tomography findings and intraoperative pathologic exploration makes intentional limited resection an acceptable option for the treatment of small peripheral NSCLC.     

Intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration

Objective: The aim of this study was to assess the adequacy of our intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration. Methods: Patients who had stage IA non-small cell lung cancer (NSCLC) with a maximum tumor diameter of 2 cm or less were candidates for limited resection. If bronchioloalveolar carcinoma (BAC) was suspected on computed tomography and intraoperative pathologic exploration revealed the lesion as BAC without foci of active fibroblastic proliferation (Noguchi type A and B), wedge resection was performed. If the tumor was not suspected of being Noguchi type A or B, extended segmentectomy with intraoperative lymph node exploration was performed. Results: Limited resection was performed in 34 patients, wedge resection in 14, and extended segmentectomy in 20. The median follow-up period after wedge resection was 36 months, and all patients are alive with no signs of recurrence. The median follow-up period after extended segmentectomy was 54 months. No local recurrences were found, but distant metastasis was diagnosed in one patient. The 5-year survival rate after extended segmentectomy was 93%. In the same period, lobectomy was performed in 57 patients with stage IA NSCLC with a maximum tumor diameter of 2 cm or less, and the 5-year survival rate was 84%. There were no significant differences in 5-year survival between extended segmentectomy and lobectomy. Conclusions: Careful selection of patients based on high-resolution computed tomography findings and intraoperative pathologic exploration makes intentional limited resection an acceptable option for the treatment of small peripheral NSCLC. Read at the Fifty-sixth Annual Meeting of the Japanese Association for Thoracic Surgery, Panel Discussion, Tokyo, November 19–21, 2003.     

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.     

Benefits of resection for metachronous lung cancer

OBJECTIVES: The benefits of resection for metachronous lung cancer are not well described. The objective of this study was to evaluate the safety and efficacy of surgical resection for metachronous lung cancers. METHODS: We reviewed the charts of all patients who underwent a second resection for a metachronous lung cancer from July 1, 1988, to December 31, 2002. Type of resection, operative morbidity, mortality, and survival by stage were analyzed. Survival was determined by using the Kaplan-Meier survival method. All patients were pathologically staged by using the 1997 American Joint Committee on Cancer standards. RESULTS: Pulmonary resections were performed in 69 patients who had undergone a previous resection. The mean interval between the first and second resection was 2.4 +/- 2.5 years. Seventy-three percent of patients presented with stage I cancers, 9% with stage II cancers, and 17% with stage III cancers. Lobectomy and wedge resection were performed with equal frequency (42% each) for the metachronous cancers. Operative mortality for the second resection was 5.8%. The mean follow-up after the second resection was 37 months. Overall 5-year actuarial survival for the entire group after the second resection was 33.4%. CONCLUSIONS: Operations for metachronous cancers provided survival that approximated the expected survival for lung cancer. Surgical intervention should be considered as a safe and effective treatment for resectable metachronous lung cancer in patients with adequate physiologic pulmonary reserve.     

Late outcome and perioperative complications for surgery of locally recurrent bronchogenic carcinoma

AIM: Many doubts involve a 2(nd) surgical approach for local relapse of non small cell lung cancer (NSCLC) since iterative resections represent a well-recognized treatment in second primary lung cancer (SPLC). METHODS: The medical reports of patients who underwent surgical resection, between 1988 and 2002, were reviewed. All patients submitted to 2(nd) operation were examined according to Martini and Melamed criteria to distinguish between local recurrence and second primary lung cancer. RESULTS: Complete resection for NSCLC was performed in 1 386 patients. Nineteen patients were submitted to surgery for local recurrence (17 men and 2 women) and mean age at the time of 1(st) operation was 61 years (range 41-78 years). The 1(st) operation consisted of lobectomy in 15 cases, anatomical segmentectomy in 2 and wedge resection in 2. The 2(nd) pulmonary resection was completion pneumonectomy in 16 cases, completion lobectomy in 2, wedge resection in 1. Major complications occurred in 26% and overall hospital mortality was 5%. Five-year survival after 2(nd) intervention was 31% and median survival 27 months. Survival was better when the time between 1(st) resection and cancer relapse was longer than 14 months and when recurrence was intrapulmonary. CONCLUSIONS: A new malignant lesion can be operated if it is solitary and intrapulmonary, if accurate staging is negative and if the patient is able to go through 2(nd) surgery from cardiopulmonary evaluation.     

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.     

Surgical management of metachronous bronchial carcinoma

Objective: To assess the results of surgery for the treatment of metachronous bronchial carcinoma. Methods: From 1985 to 1999, 38 patients were operated on for a metachronous lung carcinoma, accordingly to the criteria of Martini. All tumors were staged using the new International Classification System revised in 1997. Results: Diagnosis of the second cancer was done at radiological follow-up in 30 asymptomatic patients. Seventeen metachronous locations were ipsilateral. Histology of the metachronous lesion was the same as that of the first tumour in 23 patients (60%). The first resection was a lobectomy (n=35), a pneumonectomy (n=2) and a carinal resection (n=1). The second one was a wedge resection (n=7), a segmentectomy (n=3), a lingulectomy (n=2), a lobectomy (n=9), a bilobectomy (n=1), and a pneumonectomy (n=16). There were five in-hospital deaths (13%). Completion pneumonectomy was performed in 15 patients, with one postoperative death (7%). The overall estimated 5 and 10-years actuarial survival rates from the treatment of the first cancer were 70 and 47% respectively. The 5-year survival rate after the treatment of the second cancer was 32% (median survival: 31 months), including the operative mortality. Survival was negatively affected by a resection interval of less than 2 years and the performance of atypical lung sparing pulmonary resection for the treatment of the second cancer. Conclusions: Good long-term results are achievable by the means of a second pulmonary resection in selected patients with metachronous lung cancer. Optimal cancer operations should be applied whenever functionally possible.     

Lung resection for bronchogenic carcinoma after pneumonectomy: a safe and worthwhile procedure.

OBJECTIVES: Patients treated surgically for lung cancer can develop either a metachronous cancer or a recurrence. The appearance of a new cancer on the remaining lung after a pneumonectomy poses unique treatment problems, and surgery is often considered contraindicated. We report on the outcome of resections for lung cancer after pneumonectomy performed for lung cancer. METHODS: We reviewed the records of patients who underwent a resection of bronchogenic carcinoma on the remaining lung from 1990 to 2002. RESULTS: There were 14 patients (13 males and 1 female) with a median age of 64 years (range 51-74). Median preoperative Fev1 was 1.45 (range 1.35-2.23), corresponding to 59% of predicted Fev1 (range 46-80%). Resection was performed between 11 and 264 months after pneumonectomy (median 35.5). The resections performed were: one wedge resection in 11 patients, two wedge resections in two patients and two segmentectomies in two other patients; one patient underwent a third resection. Diagnosis was metachronous cancer in 12 patients and metastasis in two patients. Complications occurred in three patients (21%), while operative mortality was nil. Mean hospital stay was 10.5 days (6-25). Two patients received chemotherapy (one after local recurrence, one after the third resection). Overall 1, 3 and 5 year survivals were 57, 46 and 30%, respectively (median 21 months). For patients with a metachronous cancer they were 69, 55 and 37% (median 57 months), respectively, while neither patient with a metastatic tumor survived 1 year (P=0.03). CONCLUSIONS: Limited lung resection on a single lung is a safe procedure associated with acceptable morbidity and mortality rates. In patients with a metachronous lung cancer, long-term survival with a good quality of life can be obtained with limited resection on the residual lung.     

Video-assisted thoracic surgery for metachronous lung cancer

Of 1,391 patients who underwent operation for primary lung cancer between 2000 and 2009, 50 patients (3.6%) had a past history of pulmonary resection for lung cancer. Three patients underwent completion pneumonectomy by thoracotomy and in the other 47 patients video-assisted thoracic surgery (VATS) was performed. We considered 42 cases (3 of completion pneumonectomy and 39 of VATS) to be metachronous lung cancer and 8 cases of VATS to be recurrence by detailed histologic assessment. We examined 39 cases of metachronous lung cancer resected by VATS. The patients were aged 68 +/- 8 years and 4 patients were aged 80-years or more. The surgical procedures performed were lobectomy in 4 patients, segmentectomy in 3, and wedge resection in 40. The operation time was 121 +/- 66 minutes and the blood loss was 67 +/- 140 ml. There were no major complications. We registered 6 deaths during follow-up; 3 were due to disease progression and 3 were due to other causes. The survival rate of the 42 patients including 3 patients who underwent completion pneumonectomy was 74.9% at 5 years. Early detection of metachronous lung cancer and surgical resection offers a favorable prognosis.     

Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer

OBJECTIVE: The present study was undertaken to demonstrate that limited pulmonary resection for peripheral small-sized lung cancer yields outcomes not inferior to those of lobectomy. METHODS: During the 9-year period from 1992 to 2000, patients with cT1 N0 M0 peripheral non-small cell lung cancer whose maximum tumor diameter was 2 cm or less on diagnostic imaging and in whom lobectomy was determined to be feasible were treated with limited resection if the patient consented to the procedure and with lobectomy if consent to limited resection was not obtained. The survival and clinical outcome of the patients whose tumors were postoperatively staged as pT1 N0 M0 were compared between the limited resection group (n = 74) and the lobectomy group (n = 159). RESULTS: The limited resection group consisted of 60 patients treated with segmentectomy and 14 patients treated with wedge resection. Among patients followed up for a mean period of 52 months after the operation, neither the 3-year nor 5-year survivals differed significantly between the limited resection group (3-year survival, 94.0%; 5-year survival, 89.1%) and the lobectomy group (3-year survival, 97.0%; 5-year survival, 90.1%). Postoperative tumor recurrence was noted in 5 patients after limited resection and in 9 patients after lobectomy, and the difference in the incidence of postoperative recurrence between the 2 groups was not significant. CONCLUSIONS: The results of this study indicate that in patients with peripheral T1 N0 M0 non-small cell lung cancer whose maximum tumor diameter was 2 cm or less, the outcome of limited pulmonary resection is comparable with that of pulmonary lobectomy.     

Indication for limited surgery on small lung cancer tumors measuring 1cm or less in diameter on preoperative computed tomography and long-term results

OBJECTIVE: Non-invasive lung cancers showed a good prognosis after limited surgery. But it is still uncertain about invasive lung cancers. We investigated the indications for limited surgery for small lung cancer tumors measuring 1 cm or less in diameter on preoperative computed tomography (CT). METHODS: This study retrospectively analyzed of 1,245 patients who underwent complete resection of lung cancer between 1989 and 2004 in our hospital. Sixty-two patients (5%) had tumors measuring 1 cm or less in diameter. The probability of survival was calculated using the Kaplan-Meier method. RESULTS: All diseases were detected by medical checkup, 52 % of the patients were not definitively diagnosed with lung cancer before surgery. Adenocarcinoma was histologically diagnosed in 49 patients (79%). Other histologic types included squamous cell carcinoma (8), large cell carcinoma (1), small cell carcinoma (1), carcinoid (2), and adenosquamous cell carcinoma (1). Fifty-seven patients (92%) showed pathologic stage IA. The other stages were IB (2), IIA (1), and IIIB (2). There were 14 bronchioloalveolar carcinomas (25% of IA diseases). The 5-year survival rates of IA patients were 90%. The 5-year survival rate of patients with tumors measuring 1cm or less diameter was 91% after lobectomy or pneumonectomy, and 90% after wedge resection or segmentectomy. There were 3 deaths from cancer recurrence, while there were no deaths in 14 patients with bronchioloalveolar carcinoma CONCLUSION: After limited surgery, non-invasive cancer showed good long-term results, while invasive cancer showed a recurrence rate of 2.3% to 79% even though the tumor measured 1 cm or less in diameter on preoperative CT.     

Survival after resection of metachronous non-small cell lung cancer in 127 patients

BACKGROUND: In a number of patients with treated primary non-small cell lung cancer (NSCLC) a second primary tumor will be diagnosed. Our experience with surgery in these patients was analyzed and possible prognostic parameters were defined. METHODS: Patients with metachronous NSCLC (n = 127) who underwent resection from 1970 through 1997 were analyzed. All tumors were classified postsurgically. Median interval between the tumors was 3.7 years. Actuarial survival time was estimated and risk factors influencing survival were evaluated. RESULTS: Overall 5-year survival after the first resection was 70% and after the second resection was 26%. Patients with stage IA of the second primary tumor did have a significantly better survival (p < 0.005) as compared with patients with higher staged second primaries. Stage of second primary tumor and age were significant predictors of survival, whereas stage of first tumor, interval between resections, histology, and type of resection were not. CONCLUSIONS: Survival of patients with metachronous NSCLC and resection of both tumors is high, but poorer than after resection of the first tumor. Irrespective of the interval, patients with stage IA second primary tumor may benefit more from pulmonary resection.     

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.     

Multiple primary lung cancer diagnosed by thoracic computed tomography; report of 2 cases

Two cases of bilateral multiple primary lung cancers are presented. One is synchronous, and another is metachronous. Case 1: An abnormal shadow in the left lower lobe was found on the chest radiograph of 40-year-old female during a regular check-up. Chest computed tomography (CT) film showed a micronodule in the right S2. Left lower lobectomy was performed, followed by second-staged right S2 segmentectomy 1 month after the initial operation. Case 2: A 62-year-old female underwent left lower lobectomy for lung cancer in April 1997. Follow-up CT showed a nodule in right S8. In March 2000, right basal segmentectomy was performed for second lung cancer. Moreover, follow-up CT showed a nodule in right S3. Right wedge resection was performed for third lung cancer in July 2002. It is important to carefully examine a synchronous lesion before the operation of a primary lung cancer and to perform close follow-up surveillance for early detection of a metachronous lesion.