Multiple primary bronchogenic carcinomas: Treatment and follow-up

doi:10.1016/0003-4975(91)90446-W

The Annals of Thoracic Surgery

Volume 51, Issue 1, January 1991, Pages 48-51

https://doi.org/10.1016/0003-4975(91)90446-W Get rights and content

Abstract

A second primary bronchogenic carcinoma subsequently developed 8 to 156 months later in 19 patients who underwent curative resection of primary bronchogenic carcinomas. The second primary tumor was treated by surgical resection in 9 patients, 3 patients' tumors were considered unresectable, and the remaining 7 patients, despite having potentially resectable tumors, did not undergo resection because of insufficient pulmonary reserve or unwillingness to undergo resection. Actuarial life-table analysis of survival for the 9 patients who underwent resection showed a median survival time of 110.3 months compared with 19 months for the group with unresected but resectable tumors and 10.5 months for the group with unresectable tumors. There was no operative mortality in the group with resected tumors. We conclude that in patients in whom a second primary carcinoma of the lung develops, surgical resection prolongs survival and can be performed with a low operative mortality.

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Cited by (35)

Lung Resection in the Postpneumonectomy Patient
2018, Thoracic Surgery Clinics
Citation Excerpt :
After pneumonectomy for cancer, there is always a possibility of developing lesions in the contralateral lung. The risk of having recurrent carcinoma after complete resection of bronchogenic carcinoma is 2% to 5% per year,2,3 and 1% to 5% for second primary lung carcinoma.4,5 Although surgical resection is preferred for those synchronous or metachronous tumors, pulmonary resection after contralateral pneumonectomy is a challenging procedure that requires a thorough understanding of postpneumonectomy pathophysiology and the risk-benefit ratio of the procedure for that specific patient.
Pulmonary Resection for Second Lung Cancer After Pneumonectomy: A Population-Based Study
2017, Annals of Thoracic Surgery
Pulmonary resection for a second lung cancer after pneumonectomy is generally considered to be at prohibitive risk. Using a population-based database, we examined treatment patterns and survival in patients who underwent pulmonary resection after pneumonectomy for lung cancer.
We queried the Surveillance, Epidemiology, and End Results (SEER) database (1988–2012) to identify patients who underwent pneumonectomy and subsequently experienced contralateral non-small cell lung cancer (NSCLC). Multivariate logistic regression was performed to identify the factors associated with the receipt of surgical resection. Survival was estimated with the Kaplan-Meier method.
Of 13,370 patients who underwent pneumonectomy, 402 (3.0%) experienced subsequent contralateral NSCLC, and 170 (42%) met the selection criteria. Surgical resection was performed in 63 (37.1%) cases (sublobar n = 56, lobectomy, n = 7). Patients with stage I/II disease and tumor size 2 cm or smaller were more likely to undergo surgical procedures. The 1-month and 3-month mortality after resection was 11.1% (sublobar resection 10.7%, lobectomy 14.3%) and 12.7% (sublobar 12.5%, lobectomy 14.3%), respectively. The overall 1-year and 3-year survival after surgical resection was 79% and 54%, respectively. The patients who underwent sublobar resection had higher median overall survival than did those who underwent lobectomy (42 vs 18 months). Similarly, median survival after resection for metachronous tumors was higher than after resection for metastatic cancers (40 vs 28 months).
On the basis of our analysis of the SEER database, sublobar resection can be performed in selected patients with small tumors (≤2 cm) and early-stage disease (stage I/II). Although perioperative mortality is significant, the favorable 1-year and 3-year survival may justify the role of an additional procedure on the single lung.
Outcomes of pulmonary resection in single-lung patients
2015, Cirugia Espanola
La aparición de una nueva lesión pulmonar, bien un tumor metacrónico o una recidiva, en pacientes neumonectomizados plantea un reto terapéutico, en el que la cirugía en muchas ocasiones se considera contraindicada. El objetivo de nuestro estudio es valorar la morbimortalidad de la cirugía de resección pulmonar sobre pulmón único.
Revisamos a todos los pacientes a los que se les realizó una neumonectomía y presentaron una nueva lesión en el pulmón remanente entre 1994 y 2012.
La serie consta de 12 pacientes (10 varones y 2 mujeres) con una edad media de 71 años (54-81 años). El FEV₁ medio fue de 1.470 ml (54,2%) y la CVF de 2.153 ml (61,5%). Tras una mediana de 34,5 meses se les intervino de una segunda lesión en el pulmón contralateral, realizándose en todos los casos resecciones pulmonares atípicas. La anatomía patológica mostró metástasis de tumor primario pulmonar en 2 pacientes; tumor metacrónico, en 6 pacientes; metástasis de carcinoma de origen extratorácico, en 3 pacientes y nódulo benigno en un paciente. Se registraron complicaciones en 4 pacientes (33,4%): arritmia cardíaca en 2 pacientes e insuficiencia respiratoria en otros 2 pacientes. No hubo ningún fallecimiento postoperatorio.
La resección pulmonar sobre pulmón único es un procedimiento seguro con una aceptable morbimortalidad, en la que es de gran importancia una meticulosa selección de los pacientes.
After pneumonectomy, the development of a new lung cancer or a recurrence in the residual lung is a challenge. Surgery often is considered contraindicated. The goal of our study is to assess the morbidity and mortality of lung resection on a single lung.
All patients who underwent lung resection after pneumonectomy from January 1996 through December 2012 were reviewed.
There were 12 patients (10 men and 2 women). Mean age was 71 years (range, 54-81 years). Mean preoperative FEV₁ was 1470 ml (52%) and preoperative FVC 2153 ml (61,5%). Subsequent pulmonary resection was performed after a median follow-up of 34,5 months. Wedge resection was performed in all patients. Diagnosis was pulmonary mestastatic lung cancer in 2 patients, metachronous lung cancer in 6, metastatic extrathoracic cancer in 3 and benign nodule in one. Complications occurred in 4 patients (33,4%) while operative mortality was nil.
Lung resection on a single lung is a safe procedure associated with acceptable morbidity and mortality. Careful patient selection is very important.
Analysis of Second Primary Lung Cancers in the SEER Database
2010, Journal of Surgical Research
Citation Excerpt :
Prolonged life expectancy may be the common theme in these associations. In all SPLCs, including those treated both surgically and non-surgically, the reported stage at diagnosis are stage I (55%), stage II (7%), stage III (35%), and stage IV (3%) [14–16]. The early stage of diagnosis may be related to the close postoperative surveillance instituted in these studies [2, 13, 14].
We sought to examine the outcomes of second primary lung cancers in the large population-based Surveillance Epidemiology and End Results (SEER) database. We also sought to study the outcomes of synchronous second non-small-cell lung cancers (NSCLCs), classified as stage IVA (M1A) according to the seventh edition of the TNM staging for lung cancer.
Data of patients with at least two primary lung cancers were obtained. All available variables potentially associated with the incidence of a second primary lung cancer were examined. The overall survival of patients with synchronous NSCLC was compared with those with metachronous and stage IV NSCLC.
A small proportion (1.5%) of patients with lung cancer developed a second primary. A second primary is associated with younger age, female gender, earlier stage, and white race. The median survival of patients with metachronous NSCLCs (n = 3352) was worse than those with synchronous NSCLCs (n = 1858) (median survival 22 mo versus 29 mo, respectively; P < 0.01). After adjusting for age, race, gender, stage, and histology of both primaries, this difference in survival between patients with synchronous and metachronous second primary lung cancers was not statistically significant, but was better than those with stage IV NSCLC (n = 127,654; median survival 4 mo).
The incidence of second primary lung cancer is lower than that previously reported. Factors associated with good prognosis predict a second primary. Synchronous NSCLCs have an outcome better than a stage IV (M1a) designation. These patients should receive appropriate stage-specific multi-modality therapy suitable for the independent stage of each cancer without considering them unresectable.
Cost effectiveness of chest computed tomography after lung cancer resection: A decision analysis model
2005, Annals of Thoracic Surgery
Postoperative surveillance with chest computed tomography (CT) is often performed in patients who have undergone resection of non-small cell lung cancer (NSCLC), despite lack of supporting data. This study involves the creation of a decision analysis model to predict the cost effectiveness of postoperative surveillance CT.
A decision analysis model was created in which a hypothetical cohort of patients underwent annual chest CT after resection of a stage IA NSCLC. The incidence of second primary lung cancer (SPLC), sensitivity and specificity of CT, as well as survival after resection of initial primary and SPLC were derived from published literature. The cost of CT and other procedures prompted by a positive finding on CT was calculated from Medicare reimbursement schedules. Cost effectiveness was defined as a cost of less than $60,000 per quality-adjusted life-year gained in the cohort under surveillance compared with controls under no surveillance.
In the initial (base case) analysis, the cost of surveillance CT was $47,676 per quality-adjusted life-year gained, implying cost effectiveness. However, factors that rendered surveillance CT cost ineffective were (1) age at entry into the surveillance program greater than 65 years, (2) cost of CT greater than $700, (3) incidence of SPLC of less than 1.6% per patient per year of follow-up, and (4) a false positive rate of surveillance CT greater than 14%.
Surveillance with postoperative CT may be a cost-effective intervention to detect SPLC in selected patients with previously resected stage IA NSCLC.
Subsequent pulmonary resection for bronchogenic carcinoma after pneumonectomy
2002, Annals of Thoracic Surgery
Citation Excerpt :
Median survival for patients undergoing a solitary wedge excision was 59 months compared with 39 months for extended resection patients (p = 0.53). Patients with a completely resected bronchogenic carcinoma have a 5% to 10% risk of having a new lung cancer [3] and a 30% to 80% risk of having recurrent disease [2, 4]. This percentage will continue to increase as patient survival improves.
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.

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Original articleMultiple primary bronchogenic carcinomas: Treatment and follow-up

Abstract

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Chest

J Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Original article
Multiple primary bronchogenic carcinomas: Treatment and follow-up