Surgical management of metachronous bronchial carcinoma

Objective: To assess the results of surgery for the treatment of metachrono us bronchial carcinoma. Methods: From 1985 to 1999, 38 patients were operat ed on fur a metachronous lung carcinoma, accordingly to the criteria of Mar tini. All tumors were staged using the new International Classification Sys tem revised in 1997. Results: Diagnosis of the second cancer was done at ra diological follow-up in 30 asymptomatic patients. Seventeen metachronous lo cations 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 p neumonectomy (n = 16). There were Live 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 sur vival rate after the treatment of the second cancer was 32% (median surviva l: 31 months), including the operative mortality, Survival was negatively a ffected 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 ca ncer. Optimal cancer operations should he applied whenever functionally pos sible. (C) 2001 Elsevier Science B.V. All rights reserved.