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Eur J Cardiothorac Surg 2001;19:899-903
© 2001 Elsevier Science NL

Surgical management of metachronous bronchial carcinoma

Department of Thoracic Surgery, Sainte Marguerite University Hospital, Marseille France

Received 14 November 2000; accepted 19 March 2001.

Corresponding author. Tel.: +33-491-744741; fax: +33-491-744590
e-mail: cdoddoli{at}mail.ap-hm.fr

Objective: To assess the results of surgery for the treatment of metachronous bronchial carcinoma. Methods: From 1985 to 1999, 38 patients were operated on for a metachronous lung carcinoma, accordingly to the criteria of Martini. All tumors were staged using the new International Classification System revised in 1997. Results: Diagnosis of the second cancer was done at radiological follow-up in 30 asymptomatic patients. Seventeen metachronous locations were ipsilateral. Histology of the metachronous lesion was the same as that of the first tumour in 23 patients (60%). The first resection was a lobectomy (n=35), a pneumonectomy (n=2) and a carinal resection (n=1). The second one was a wedge resection (n=7), a segmentectomy (n=3), a lingulectomy (n=2), a lobectomy (n=9), a bilobectomy (n=1), and a pneumonectomy (n=16). There were five in-hospital deaths (13%). Completion pneumonectomy was performed in 15 patients, with one postoperative death (7%). The overall estimated 5 and 10-years actuarial survival rates from the treatment of the first cancer were 70 and 47% respectively. The 5-year survival rate after the treatment of the second cancer was 32% (median survival: 31 months), including the operative mortality. Survival was negatively affected by a resection interval of less than 2 years and the performance of atypical lung sparing pulmonary resection for the treatment of the second cancer. Conclusions: Good long-term results are achievable by the means of a second pulmonary resection in selected patients with metachronous lung cancer. Optimal cancer operations should be applied whenever functionally possible.

Key Words: Second primary lung cancer • Resection • Follow-up

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