RESULTS OF REPEATED LUNG RESECTION FOR HO MOLATERAL RECURRENCE OF LUNG-CANCER AFTER CONSERVATIVE RESECTION

From 1978 through 1992, 93 patients with a previous lobectomy for bron chogenic cancer were referred for homolateral cancer recurrence. Forty -six patients were contraindicated for carcinologic reasons (30 stage IIIb and 16 stage IV). Forty-seven patients (50.5%) were resectable, b ut 17 did not undergo surgery for associated medical problems (n = 11) or refusal (n = 6). The remaining 30 patients form the population of the present study: 29 males and 1 female; mean age of 61 years (range 47-72). The previous cancer was stage I in 26 and stage II in 4. The m ean interval between the 2 cancer diagnoses was 30 months (range 6-97) . Three patients underwent an exploratory thoracotomy (10%): 2 had med iastinal involvement and 1 had pleural metastases. Twenty-two (73%) un derwent a completion pneumonectomy, and 5 had miscellaneous conservati ve resections. There were 4 operative deaths (13%): one intraoprative bleeding, 1 postoperative bleeding, 1 pulmonary embolism, 1 pneumonia. Four patients had nonfatal surgical complications: 2 clottings (reexp loration), 1 empyema (lavage) and 1 bronchopleural fistula (thoracopla sty). Resected patients were staged as follows: 13 stage I, 4 stage II , 10 stage IIIm. Survival following resection including operative mort ality at 3 an 5 years was estimated as 52.5% and 44% for the whole ser ies (72% for stage I). We conclude that repeat surgery conveys an incr eased risk, but may achieve valuable long-term results.