Abstract
Objective. We conducted this study to determine the operative indication for multiple primary lung cancer, including the selection of the type of pulmonary resection, by analyzing the outcome, operative mortality and morbidity. Patients and Methods. We studied 64 patients with multiple primary lung cancer who underwent surgical treatment. Results. The average age at initial treatment was 64.3 years old. There were 49 men and 15 women. We operated on 64 patients for multiple primary lung cancer, which appeared to be synchronous in 27 cases and metachronous in 37 cases. There were two adenocarcinomas in different locations in 27 patients, two squamous cell carcinomas in 14, and the combination of an adenocarcinoma and a squamous cell carcinoma in 11. Thirty-five patients had two lesions diagnosed as p-stage I. Fourteen patients had a p-stage I lesion and a p-stage II lesion. In synchronous lung cancer, 14 patients underwent operation simultaneously, 11 patients underwent operation in two stages. Of 43 patients who underwent operations twice or more, 27 patients underwent lobectomies on the first operation. On the other hand, 28 patients underwent limited surgery on the second operation. Four patients underwent a lobectomy twice for metachronous bilateral lesions and three patients underwent completion pneumonectomy at the second operation. We encountered no operative death and no severe complications after surgery. The 5-year survival rate of the patients with synchronous and metachronous disease from the final treatment was 63.9% and 74.9%, respectively. The 5-year survival rate of the patients with p-stage IA disease in the second lesion of metachronous lung cancer was 85.1%, and that for patients with p-stage IB disease was 66.7%. The survival rate of the patients with p-stage II or more advanced second lesion was significantly less than that with p-stage I disease. The outcome of patients with two primary adenocarcinomas was the best (5-year survival: 81.5%) after analysis of patients by histological types. Conclusions. Surgical treatment for patients with multiple primary lung cancer was generally safe without any severe complications. We performed bilateral lobectomies in two stages or completion pneumonectomy after considering their predicted post-operative pulmonary function and performance status. We conclude that an aggressive surgical approach is recommended for the treatment for multiple primary lung cancer, especially for stage I disease, as it yield good survival.
