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Resection for second and third primary lung cancer

L P Faber1

  • 1Department of Cardiovascular-Thoracic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612.

Seminars in Surgical Oncology
|March 1, 1993
PubMed
Summary
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Patients with new primary lung cancers can undergo a second or third thoracotomy. Surgical resection offers the best chance for long-term survival in these high-risk lung cancer patients.

Area of Science:

  • Thoracic Surgery
  • Oncology
  • Pulmonary Medicine

Background:

  • Increasing incidence of bronchogenic carcinoma leads to higher rates of secondary and tertiary primary lung tumors.
  • Identifying patients eligible for repeat surgical intervention is critical for improving outcomes.

Purpose of the Study:

  • To evaluate the safety and efficacy of repeat thoracotomy for patients with new primary lung cancers.
  • To assess survival rates following surgical resection of second or third primary lung tumors.

Main Methods:

  • Retrospective analysis of 132 patients undergoing second (n=114) or third (n=18) thoracotomy for new primary lung cancers.
  • Criteria for new primary tumors included different histology, 24-month tumor-free interval, contralateral location, or distinct ipsilateral lobe.

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  • 73 segmental resections were performed to minimize complications.

    • Main Results:

    • Operative mortality was 8.8% for second resections and 1/18 for third resections.
    • Cumulative survival after second resection was 33% at 5 years and 20% at 10 years.
    • Conservative resection strategies were employed to reduce postoperative complications.

    Conclusions:

    • Early detection and surgical resection of second and third primary lung cancers are crucial.
    • Repeat thoracotomy is a viable option for selected patients, offering the best chance for long-term survival.
    • Careful patient selection and conservative surgical approaches are important for managing these complex cases.