Surgical Treatments for Multiple Primary Adenocarcinoma of the Lung

doi:10.1016/j.athoracsur.2004.03.102

The Annals of Thoracic Surgery

Volume 78, Issue 4, October 2004, Pages 1194-1199

https://doi.org/10.1016/j.athoracsur.2004.03.102 Get rights and content

Abstract

Background

The aim of this study was to identify the clinical characteristics of multiple primary adenocarcinomas and to evaluate the efficacy of surgical treatments.

Methods

Three-hundred sixty-nine patients who underwent pulmonary resection for adenocarcinoma from January 1994 to December 2002 were reviewed.

Results

Thirty-one patients (8.4%) were determined to have multiple primary adenocarcinomas that could be detected on chest x-rays or computed tomography (CT). Twenty-six patients were synchronous and five patients were metachronous with a median interval of 59.0 months. Forty-nine (72.1%) of the total 68 lesions exhibited ground-glass opacity on high-resolution CT (HRCT). Pathologically well-differentiated adenocarcinoma with mixed bronchioloalveolar pattern was the most common subtype (39.7%). Taking into consideration pulmonary function, size, location, and HRCT findings of the lesions the procedures performed were lobectomy with mediastinal lymph-node dissection for 32 patients, segmentectomy with hilar node dissection for 8 patients, and wedge resection for 28 patients. Of 17 patients with bilateral synchronous cancers, simultaneous bilateral pulmonary resection was performed in 14 patients including simultaneous bilateral video-assisted thoracic surgery (VATS) in 11 patients. After a median follow-up period of 27.7 months, the 3-year overall survival rate was 92.9% and the 3-year disease-free survival rates of synchronous cancer and metachronous cancer were 77.9% and 100%, respectively.

Conclusions

The incidence of multiple primary adenocarcinomas was relatively common. Early radiographic detection and surgical excision could yield a favorable prognosis. The use of VATS, even for synchronous bilateral patients, was a safe and beneficial procedure.

Section snippets

Patients and Methods

From January 1994 to December 2002, 517 patients underwent pulmonary resection for non-small cell lung cancer at the National Shikoku Cancer Center (Ehime, Japan). All patients underwent preoperative examinations including plain chest roentgenogram, HRCT of the chest, ultrasonography of the upper abdomen, magnetic resonance imaging of the brain, and bone scintigraphy. There were 369 patients with adenocarcinoma, 111 with squamous cell carcinoma, 19 with adenosquamous carcinoma, 15 with large

Results

Thirty-one patients exhibited primary multiple adenocarcinomas; that corresponded to 8.4% of the total 369 adenocarcinoma patients who underwent surgical resection during the same period. There were 12 males and 19 females with a median age of 68.1 years (range, 47–81). Thirteen patients (41.9%, 11 male and 2 female) exhibited a history of smoking. The incidence of primary multiple adenocarcinomas was substantially higher in female and nonsmokers than that of other histologic multiple lung

Comment

In our retrospective study, 7.9% of surgically resected non-small cell lung cancers and 8.4% of adenocarcinomas exhibited multiple lesions. The incidence of multiple primary lung cancer in our study was comparable with that in previous studies that reported an incidence of 1%–10% 9, 15, 16. However a higher incidence of multiple synchronous adenocarcinomas was a marked characteristic of our series compared with previous reports 8, 10, 17, 18. Even if our study exhibits a limitation of a short

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Original article: general thoracicSurgical Treatments for Multiple Primary Adenocarcinoma of the Lung

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Comment

Lancet

Lung Cancer

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Chest

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Chest

Peripheral lung cancerscreening and detection with low-dose spiral CT versus radiography

Radiology

Screening for lung cancer with low-dose helical computed tomographyAnti-lung cancer association project

J Clin Oncol

Original article: general thoracic
Surgical Treatments for Multiple Primary Adenocarcinoma of the Lung