[Surgical resection for postoperative local recurrent lung cancer]

Reported recurrence rates after complete surgical resection range from 30 to 70%, depending on the final pathologic stage. Of these, 30 to 40% were local recurrent cancers. Chemotherapy and radiation therapy are commonly accepted treatment options for recurrent lung cancer, whereas surgical resection is limited to a relatively few patients. In this paper, we reviewed the current status of surgical resection for local recurrent lung cancer. Sites of local recurrences are defined as tumor in the ipsilateral lung, staple line, bronchial stump, and regional lymph nodes, which are potentially amenable to surgery. Surgical treatment of lung recurrence including ipsilateal lung or staple line, or sites of chest other than lung suggested a survival benefit in the recent retrospective studies. However, completion pneumonectomy or lobectomy has to be performed in almost of these cases, it is mandatory to evaluate an indication for re-operation by some general rules. During operation, surgeons considered a severe adhesion surrounding the bronchial stump and pulmonary artery because the manipulation of initial surgery occurred in the fibrosis of hilum and mediastinum. Surgeons should not hesitate to undergo standard thoracotomy through poster-lateral or median incision. It is secure to dissect main pulmonary artery in the pericardium for preparing the emergent bleeding or reconstruction. Handling suture for bronchial stump is necessary because it allows only a short margin to sew up. The perioperative management is based upon the post-pneumonectomy.