Iterative surgical resections for local recurrent and second primary bronchogenic carcinoma

Objective: To report our experience with repeated pulmonary resection in pa tients with local recurrent and second primary bronchogenic carcinoma. to a ssess operative mortality and late outcome, Methods: The medical records of all patients who underwent a second lung resection for local recurrent and second primary bronchogenic carcinoma from 1978 through 1998 were reviewed . Results: There were 27 patients. They constituted 2.5% of 1059 patients w ho had undergone lung resection for bronchogenic carcinoma in the same peri od. Twelve patients (1.1%) (group 1) had a local recurrence that developed at a median interval of 24 months (range 4-83). The first pulmonary resecti on was lobectomy in ten patients and segmentectomy in two. The second opera tion consisted of completion pneumonectomy in ten cases, completion lobecto my in one and wedge resection of the right lower lobe after a right upper l obectomy in one. The other 15 patients (1.4%) (group 2) had a new primary l ung cancer that developed at a median interval of 45 months (range 21-188). The first pulmonary resection was lobectomy in 12 patients, bilobectomy in one and pneumonectomy in two. The second pulmonary resection was controlat eral lobectomy in seven patients, controlateral sleeve lobectomy in two, co ntrolateral pneumonectomy in 1, controlateral wedge resection in four and c ompletion pneumonectomy in one. Overall hospital mortality was 7.4%, includ ing one intraoperative and one postoperative death in group 1 and 2, respec tively. Five-year survival after the second operation was 15.5 and 43% with a median survival of 26 and 49 months in groups 1 and 2, respectively (P = ns). Conclusions: Long-term results justify complete work-up of patients w ith local recurrent and second primary bronchogenic carcinoma. Treatment sh ould be surgical, if there is no evidence of distant metastasis and the pat ients are in good health. Early detection of second lesions is possible wit h an aggressive follow-up conducted maximally at 4 months intervals for the first 2 years and 6 months intervals thereafter throughout life. (C) 2000 Published by Elsevier Science B.V.