Top

Surgery Today

Published in:

01-02-2015 | Original Article

Clinical features of multiple lung cancers based on thin-section computed tomography: What are the appropriate surgical strategies for second lung cancers?

Authors: Aritoshi Hattori, Kenji Suzuki, Kazuya Takamochi, Shiaki Oh

Published in: Surgery Today | Issue 2/2015

Abstract

Purpose

We investigated the proper surgical strategies for second lung cancers based on the findings of thin-section CT.

Methods

We classified 59 patients with second lung cancers into two categories based on the thin-section CT findings. In the ground glass nodule (GGN) group (n = 29), the first and/or the second lung cancers showed a GGN on thin-section CT. In the Solid group (n = 30), both the first and second lung cancers showed a solid appearance.

Results

The overall 5-year survival rate after second surgery was 71.7 %. The univariate analyses revealed that the presence of more than three lung tumors was significantly more common in the GGN group. Regarding the surgical strategies, all the patients in the GGN group underwent limited resection for at least one of the operations, whereas 36 % of those in the Solid group underwent bilateral lobectomy. The 5-year survival in the GGN group (89.1 %) was significantly better than that in the Solid group (40.8 %) (p = 0.0305).

Conclusions

Limited resection should be performed for GGN patients as much as possible to preserve lung function, due to the possible presence of more than three lung cancers. Despite the higher likelihood of having more tumors, the GGN patients had a better survival. In contrast, lobectomy for second lesions should be aggressively considered for solid tumor patients whenever possible.

Surapaneni R, Singh P, Rajagopalan K, Hageboutros A. Stage I lung cancer survivorship: risk of second malignancies and need for individualized care plan. J Thorac Oncol. 2012;7(8):1252–6.PubMedCrossRef

Johnson BE. Second lung cancers in patients after treatment for an initial lung cancer. J Natl Cancer Inst. 1998;90(18):1335–45.PubMedCrossRef

Shah AA, Barfield ME, Kelsey CR, Onaitis MW, Tong B, Harpole D, et al. Outcomes after surgical management of synchronous bilateral primary lung cancers. Ann Thorac Surg. 2012;93(4):1055–60 (discussion 1060).PubMedCrossRef

Fabian T, Bryant AS, Mouhlas AL, Federico JA, Cerfolio RJ. Survival after resection of synchronous non-small cell lung cancer. J Thorac Cardiovasc Surg. 2011;142(3):547–53.PubMedCrossRef

De Leyn P, Moons J, Vansteenkiste J, Verbeken E, Van Raemdonck D, Nafteux P, et al. Survival after resection of synchronous bilateral lung cancer. Eur J Cardiothorac Surg. 2008;34(6):1215–22.PubMedCrossRef

Tsunezuka Y, Matsumoto I, Tamura M, Oda M, Ohta Y, Shimizu J, et al. The results of therapy for bilateral multiple primary lung cancers: 30 years experience in a single centre. Eur J Surg Oncol. 2004;30(7):781–5.PubMedCrossRef

Aziz TM, Saad RA, Glasser J, Jilaihawi AN, Prakash D. The management of second primary lung cancers. A single centre experience in 15 years. Eur J Cardiothorac Surg. 2002;21(3):527–33.PubMedCrossRef

Adebonojo SA, Moritz DM, Danby CA. The results of modern surgical therapy for multiple primary lung cancers. Chest. 1997;112(3):693–701.PubMedCrossRef

Angeletti CA, Mussi A, Janni A, Lucchi M, Ribechini A, Chella A, et al. Second primary lung cancer and relapse: treatment and follow-up. Eur J Cardiothorac Surg. 1995;9(11):607–11.PubMedCrossRef

10.

Chang YL, Wu CT, Lee YC. Surgical treatment of synchronous multiple primary lung cancers: experience of 92 patients. J Thorac Cardiovasc Surg. 2007;134(3):630–7.PubMedCrossRef

11.

Deschamps C, Pairolero PC, Trastek VF, Payne WS. Multiple primary lung cancers. Results of surgical treatment. J Thorac Cardiovasc Surg. 1990;99(5):769–77 (discussion 777–778).PubMed

12.

Rea F, Zuin A, Callegaro D, Bortolotti L, Guanella G, Sartori F. Predictors of outcomes after surgical treatment of synchronous primary lung cancers. J Thorac Oncol. 2010;5(2):197–205.CrossRef

13.

Nakata M, Sawada S, Yamashita M, Saeki H, Kurita A, Takashima S, et al. Surgical treatments for multiple primary adenocarcinoma of the lung. Ann Thorac Surg. 2004;78(4):1194–9.PubMedCrossRef

14.

Okada M, Tsubota N, Yoshimura M, Miyamoto Y. Operative approach for multiple primary lung carcinomas. J Thorac Cardiovasc Surg. 1998;115(4):836–40.PubMedCrossRef

15.

Rea F, Zuin A, Callegaro D, Bortolotti L, Guanella G, Sartori F. Surgical results for multiple primary lung cancers. Eur J Cardiothorac Surg. 2001;20(3):489–95.PubMedCrossRef

16.

Trousse D, Barlesi F, Loundou A, Tasei AM, Doddoli C, Giudicelli R, et al. Synchronous multiple primary lung cancer: an increasing clinical occurrence requiring multidisciplinary management. J Thorac Cardiovasc Surg. 2007;133(5):1193–200.PubMedCrossRef

17.

Bae MK, Byun CS, Lee CY, Lee JG, Park IK, Kim DJ, et al. The role of surgical treatment in second primary lung cancer. Ann Thorac Surg. 2011;92(1):256–62.PubMedCrossRef

18.

Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg. 1975;70(4):606–12.PubMed

19.

Mitsudomi T, Yatabe Y, Koshikawa T, Hatooka S, Shinoda M, Suyama M, et al. Mutations of the P53 tumor suppressor gene as clonal marker for multiple primary lung cancers. J Thorac Cardiovasc Surg. 1997;114(3):354–60.PubMedCrossRef

20.

Matsuzoe D, Hideshima T, Ohshima K, Kawahara K, Shirakusa T, Kimura A. Discrimination of double primary lung cancer from intrapulmonary metastasis by p53 gene mutation. Br J Cancer. 1999;79(9–10):1549–52.PubMedCentralPubMedCrossRef

21.

Girard N, Deshpande C, Azzoli CG, Rusch VW, Travis WD, Ladanyi M, et al. Use of epidermal growth factor receptor/Kirsten rat sarcoma 2 viral oncogene homolog mutation testing to define clonal relationships among multiple lung adenocarcinomas: comparison with clinical guidelines. Chest. 2010;137(1):46–52.PubMedCrossRef

22.

Antakli T, Schaefer RF, Rutherford JE, Read RC. Second primary lung cancer. Ann Thorac Surg. 1995;59(4):863–6 (discussion 867).PubMedCrossRef

23.

Asamura H. Multiple primary cancers or multiple metastases, that is the question. J Thorac Oncol. 2010;5(7):930–1.PubMedCrossRef

24.

Suzuki K, Kusumoto M, Watanabe S, Tsuchiya R, Asamura H. Radiologic classification of small adenocarcinoma of the lung: radiologic–pathologic correlation and its prognostic impact. Ann Thorac Surg. 2006;81:413–9.PubMedCrossRef

25.

Hattori A, Suzuki K, Matsunaga T, Fukui M, Kitamura Y, Miyasaka Y, et al. Is limited resection appropriate for radiologically “solid” tumors in small lung cancers? Ann Thorac Surg. 2012;94:212–5.PubMedCrossRef

Title: Clinical features of multiple lung cancers based on thin-section computed tomography: What are the appropriate surgical strategies for second lung cancers?
Authors: Aritoshi Hattori
Kenji Suzuki
Kazuya Takamochi
Shiaki Oh
Publication date: 01-02-2015
Publisher: Springer Japan
Published in: Surgery Today / Issue 2/2015
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-014-0921-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical features of multiple lung cancers based on thin-section computed tomography: What are the appropriate surgical strategies for second lung cancers?

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2015

Early initiation of oral feeding following upper gastrointestinal tumor surgery: a randomized controlled trial

A novel laparoscopic approach for severe esophageal stenosis due to reflux esophagitis: how to do it

Successful laparoscopic gastric resection and safe introduction of a single-incision technique for gastric submucosal tumors located near the esophagogastric junction

Port-site recurrence after complete resection of stage I thymoma by video-assisted thoracoscopic surgery: report of a case

Risk factors for bowel necrosis in patients with hepatic portal venous gas

The history of lymphadenectomy for esophageal cancer and the future prospects for esophageal cancer surgery