Surgical results for multiple primary lung cancers

Objective: The development of a multiple primary lung cancer (MPLC) is not rare in long-term survivors after curative resections. We analysed our expe rience in order to verify surgical results and long-term survival in our pa tients. Methods: From 1971 to 1999, 80 patients with MPLC (two tumours each , total 160) were treated at the Division of Thoracic Surgery of the Univer sity of Padua. Our criteria for the definition of a synchronous or metachro nous cancer are those proposed by Martini and Melamed. We had 19 patients w ith a synchronous tumour and 61 patients with a metachronous tumour. We per formed 95 lobectomies, 5 completion pneumonectomies and 53 segmentectomies. Of 160 MPLCs, 60 were squamous carcinomas, 78 adenocarcinomas, 8 small cel l lung cancers, 9 large cell lung cancers and 5 other tumours. Of 160 MPLCs , 140 were N0 disease (87.5%) and 20 were N1 or N2 disease (12.5%). Results : The overall 30-day mortality was 2.5% (2 patients). Eighteen patients (22 .5%) had postoperative complications. Survival at 5 and 10 years for all pa tients was 72% and 58%, respectively. Five-year survival for patients with metachronous and synchronous disease from the time of initial diagnosis of cancer was 85% and 20% (P=0.001), and 10-year survival was 58% and 0% (P=0. 001), respectively. Survival after the development of a metachronous lesion was 51% at 5 years and 20% at 10 years. The 5-year survival of patients wi th metachronous tumours undergoing standard surgical procedures of the seco nd tumour was 52%; the 5-year survival of patients undergoing atypical or s egmental resections was 55%. Conclusions: Careful follow-up is recommended in all patients surviving curative resection. More accurate selection crite ria for MPLC is required. An aggressive surgical approach is justified in p atients with MPLC and offers the greatest chance for long-term survival eve n in the case of limited resection. (C)2001 Elsevier Science B.V. All right s reserved.