[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.