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Six radical surgeries for metachronous multiple primary lung cancer: A case report
Hideomi Ichinokawa1, Takashi Sowa2, Takashi Yaguchi2
1Department of General Thoracic Surgery, Juntendo University Shizuoka Hospital, Shizuoka, Japan; Department of General Thoracic Surgery, Juntendo University Hospital, Tokyo, Japan.
Introduction And Importance:
Comprehensive reports on surgery for metachronous multiple primary lung cancers after the third or subsequent surgeries are lacking. Herein, we report a case in which six radical surgeries were performed for metachronous primary lung cancer.
Case Presentation:
The patient was a 62-year-old man when he underwent his first surgery, a right lower lobectomy, and the pathological diagnosis was adenocarcinoma. Fifteen years after the first surgery, when the patient was 77 years, an 11-mm nodule was found in right segment 2a, and it had been growing for 3 years; thus, he underwent his sixth surgery. Surgery involved adhesion removal (duration, 90 min) and right upper wedge resection. A delayed pulmonary fistula developed on postoperative day (POD) 11, and adhesion therapy was performed six times, but no improvement was observed; therefore, fenestration was performed on POD 28. The patient progressed well, and he was discharged home on POD 58. However, his nutritional status gradually deteriorated, and he died of pneumonia 5 months after surgery.
Clinical Discussion:
Third or subsequent surgeries are expected to increase the risk of prolonged operation time, increased bleeding, and prolonged air leakage as surgical complications. In addition, strong adhesions, especially in the hilar area, make it very difficult to identify and fix existing structures, especially the pulmonary artery and vein, and increase the risk of injury.
Conclusion:
When planning multiple metachronous lung cancer surgeries, it is important to consider bleeding and adhesions during the next surgery, plan thoracoscopic surgery, and minimize air leakage during surgery.
