2ND PRIMARY LUNG-CANCER AND RELAPSE - TREATMENT AND FOLLOW-UP

During a 14-year period (1980-1993) second primary lung cancer or rela pse was treated in 44 consecutive patients, Thirty-seven patients had synchronous (n = 18) or metachronous (n = 19) second primary lung canc er, Ten synchronous tumors were ipsilateral and treated contemporarily with five pneumonectomies, three lobectomies and two double wedge res ections. The bilateral synchronous lesions (8 patients) were treated b y staged bilateral thoracotomy (mean interval; 2 months). The first re section consisted of a lobectomy in six patients and wedge resection i n two, The second one was a wedge resection in six patients and a lobe ctomy in two, In the metachronous presentation 15 patients (79%) were asymptomatic and detected by follow-up chest X-ray, In this group the first operation was a lobectomy in 12 patients, a wedge resection or s egmentectomy in 6 and a pneumonectomy in 1, The second one was a wedge resection in nine patients, a lobectomy in six and completion pneumon ectomy in four, Seven patients, all of them asymptomatic, had local re currence from their primary lung cancer, The first lung resection was a lobectomy in five patients and a wedge resection in two, The second one was completion pneumonectomy in five patients and completion lobec tomy in two, We had no operative death, The actuarial overall 5-year s urvival rate after the second pulmonary resection for second primary l ung cancer was 38.3% with a median survival time of 13.5 months, The s ynchronous presentation had a better survival than the metachronous on e (46.2% and 25.9%), respectively), The actuarial overall 5-year survi val rate for patients with relapse was 38.1% with a median survival ti me of 37 months, We may conclude that an aggressive surgical approach is safe, effective and warranted in patients with either a second prim ary lung cancer or relapse from their primary lung cancer, Moreover, f or early detection of the second lesions, follow-up at a maximum of 6- monthly intervals should be continued for more than 5 years after the first resection.