[Reoperation for Secondary Cancer Following the Excision of Pulmonary Cancer]

There has been an increase in cases in which complete recovery is possible through surgery thanks to improvements in multimodal therapy along with increased early-stage pulmonary cancer in conjunction with the spread of pulmonary cancer computed tomography (CT) examinations and advancements in image diagnostic technologies. Moreover, post-operative follow-ups are now conducted for a relatively longer period of time, so there are now more opportunities to treat secondary cancer. It is difficult to determine if nodules that occur following pulmonary cancer surgery are cases of secondary cancer or cases of relapse. In the case of a solitary nodule, it cannot be assumed that there has been a complete recovery from cancer, so reoperation should be actively considered. In the event of reoperation, not only should the expected post-operative pulmonary function be considered, but whether the location is the same lung or the other lung, the blood flow distribution of the remaining lung, as well as other factors, should also be considered. Reoperation on the same lung is extremely difficult because it assumes a high degree of accretion in the cavum thoracis. Even if reduction surgery or lobectomy of the remaining lung is planned, separation is difficult, with potential unforeseen conditions such as hemorrhaging. Therefore, this assumes unavoidable total extirpation of the remaining lung. Regarding reoperation on the other lung, attention must be paid to management of the respiratory system during surgery. Further, blood circulation relies on the lung in which the reoperation is to be performed more than expected, with cases existing in which complications such as pulmonary edema may occur due to a rapid reduction of the pulmonary vascular bed as a result of a pulmonary resection. In particular, attention must be paid to respiratory failure and heart failure in the event of a lobectomy in both lungs. Prior to surgery, it is beneficial to evaluate the blood distribution with a pulmonary blood flow scintigram. As suggested above, reoperation on secondary cancer following pulmonary cancer excision requires a detailed treatment plan before the operation.