Thorac Cardiovasc Surg 2021; 69(04): 373-379
DOI: 10.1055/s-0040-1710068
Original Thoracic

Outcomes after Contralateral Anatomic Surgical Resection in Multiple Lung Cancer

Alex Fourdrain
1   Department of Thoracic Surgery, Amiens University Hospital, Amiens, France
,
Patrick Bagan
1   Department of Thoracic Surgery, Amiens University Hospital, Amiens, France
2   Department of Thoracic and Vascular Surgery, Victor Dupouy Hospital, Argenteuil, France
,
Olivier Georges
1   Department of Thoracic Surgery, Amiens University Hospital, Amiens, France
,
Sophie Lafitte
1   Department of Thoracic Surgery, Amiens University Hospital, Amiens, France
,
Florence De Dominicis
1   Department of Thoracic Surgery, Amiens University Hospital, Amiens, France
,
Jonathan Meynier
3   Department of Biostatistics, Clinical Research and Innovation Directorate, Amiens University Hospital, Amiens, France
,
Pascal Berna
1   Department of Thoracic Surgery, Amiens University Hospital, Amiens, France
› Author Affiliations

Abstract

Background Patients treated surgically for lung cancer may present synchronous or metachronous lung cancers. The aim of this study was to evaluate outcomes after a second contralateral anatomic surgical resection for lung cancer.

Methods We performed a retrospective two-center study, based on a prospective indexed database. Included patients were treated surgically by bilateral anatomic surgical resection for a second primary lung cancer. We excluded nonanatomic resections, benign lesions, and ipsilateral second surgical resections.

Results Between January 2011 and September 2018, 55 patients underwent contralateral anatomic surgical resections for lung cancer, mostly for metachronous cancers. The first surgical resection was a lobectomy in most cases (45 lobectomies: 81.8%, 9 segmentectomies: 16.4%, and 1 bilobectomy: 1.8%), and a video-assisted thoracic surgery (VATS) procedure was used in 23 cases (41.8%). The mean interval between the operations was 38 months, and lobectomy was less frequent for the second surgical resection (35 lobectomies: 63.6% and 20 segmentectomies: 36.4%), with VATS procedures performed in 41 cases (74.5%). Ninety-day mortality was 10.9% (n = 6), and 3-year survival was 77%. Risk factor analysis identified the number of resected segments during the second intervention or the total number of resected segments, extent of resection (lobectomy vs. segmentectomy), surgical approach (thoracotomy vs. VATS), tumor stage, and nodal involvement as potential prognostic factors for long-term survival.

Conclusion A second contralateral anatomic surgical resection for multiple primary lung cancer is possible, with a higher early mortality rate, but acceptable long-term survival, and should be indicated for carefully selected patients.

Note

This article was submitted and accepted for the Poster Session at the 27th European Conference on General Thoracic Surgery in Dublin, Ireland, June 9–12, 2019.




Publication History

Received: 28 January 2020

Accepted: 09 March 2020

Article published online:
22 May 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Pezzi CM, Mallin K, Mendez AS, Greer Gay E, Putnam Jr JB. Ninety-day mortality after resection for lung cancer is nearly double 30-day mortality. J Thorac Cardiovasc Surg 2014; 148 (05) 2269-2277
  • 2 Beyreuther, H. Multiplicität von Carcinomen bei einem Fall von sog. “Schneeberger” Lungenkrebs mit Tuberkulose. Virchows Arch Path Anat 1924;250:230–243. https://doi.org/10.1007/BF01891568
  • 3 Rea F, Zuin A, Callegaro D, Bortolotti L, Guanella G, Sartori F. Surgical results for multiple primary lung cancers. Eur J Cardiothorac Surg 2001; 20 (03) 489-495
  • 4 Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg 1975; 70 (04) 606-612
  • 5 Trousse D, Barlesi F, Loundou A. et al. Synchronous multiple primary lung cancer: an increasing clinical occurrence requiring multidisciplinary management. J Thorac Cardiovasc Surg 2007; 133 (05) 1193-1200
  • 6 Vansteenkiste J, De Ruysscher D, Eberhardt WE. et al; ESMO Guidelines Working Group. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 (Suppl. 06) vi89-vi98
  • 7 Leventakos K, Peikert T, Midthun DE. et al. Management of multifocal lung cancer: results of a survey. J Thorac Oncol 2017; 12 (09) 1398-1402
  • 8 Zhou H, Kang X, Dai L. et al. Efficacy of repeated surgery is superior to that of non-surgery for recurrent/second primary lung cancer after initial operation for primary lung cancer. Thorac Cancer 2018; 9 (08) 1062-1068
  • 9 Chang YL, Wu CT, Lee YC. Surgical treatment of synchronous multiple primary lung cancers: experience of 92 patients. J Thorac Cardiovasc Surg 2007; 134 (03) 630-637
  • 10 Fabian T, Bryant AS, Mouhlas AL, Federico JA, Cerfolio RJ. Survival after resection of synchronous non-small cell lung cancer. J Thorac Cardiovasc Surg 2011; 142 (03) 547-553
  • 11 Jung EJ, Lee JH, Jeon K. et al. Treatment outcomes for patients with synchronous multiple primary non-small cell lung cancer. Lung Cancer 2011; 73 (02) 237-242
  • 12 Kocaturk CI, Gunluoglu MZ, Cansever L. et al. Survival and prognostic factors in surgically resected synchronous multiple primary lung cancers. Eur J Cardiothorac Surg 2011; 39 (02) 160-166
  • 13 Voltolini L, Rapicetta C, Luzzi L. et al. Surgical treatment of synchronous multiple lung cancer located in a different lobe or lung: high survival in node-negative subgroup. Eur J Cardiothorac Surg 2010; 37 (05) 1198-1204
  • 14 Battafarano RJ, Force SD, Meyers BF. et al. Benefits of resection for metachronous lung cancer. J Thorac Cardiovasc Surg 2004; 127 (03) 836-842
  • 15 Mathisen DJ, Jensik RJ, Faber LP, Kittle CF. Survival following resection for second and third primary lung cancers. J Thorac Cardiovasc Surg 1984; 88 (04) 502-510
  • 16 Zhao H, Yang H, Han K. et al. Clinical outcomes of patients with metachronous second primary lung adenocarcinomas. OncoTargets Ther 2017; 10: 295-302
  • 17 De Leyn P, Moons J, Vansteenkiste J. et al. Survival after resection of synchronous bilateral lung cancer. Eur J Cardiothorac Surg 2008; 34 (06) 1215-1222
  • 18 Shah AA, Barfield ME, Kelsey CR. et al. Outcomes after surgical management of synchronous bilateral primary lung cancers. Ann Thorac Surg 2012; 93 (04) 1055-1060 , discussion 1060
  • 19 Hattori A, Suzuki K, Takamochi K, Oh S. Is bilateral pulmonary lobectomy feasible in patients with bilateral lung cancers?. Thorac Cardiovasc Surg 2015; 63 (07) 589-596
  • 20 Yang H, Sun Y, Yao F. et al. Surgical therapy for bilateral multiple primary lung cancer. Ann Thorac Surg 2016; 101 (03) 1145-1152
  • 21 Yang X, Zhan C, Li M. et al. Lobectomy versus sublobectomy in metachronous second primary lung cancer: a propensity score study. Ann Thorac Surg 2018; 106 (03) 880-887
  • 22 Stiles BM. Say goodbye to Martini and Melamed: genomic classification of multiple synchronous lung cancer. J Thorac Dis 2017; 9 (01) E87-E88