Benefits of resection for metachronous lung cancer.
OBJECTIVE
The benefits of resection for metachronous lung cancer are not well described. The objective of this study was to evaluate the safety and efficacy of surgical resection for metachronous lung cancers.


METHODS
We reviewed the charts of all patients who underwent a second resection for a metachronous lung cancer from July 1, 1988, to December 31, 2002. Type of resection, operative morbidity, mortality, and survival by stage were analyzed. Survival was determined by using the Kaplan-Meier survival method. All patients were pathologically staged by using the 1997 American Joint Committee on Cancer standards.


RESULTS
Pulmonary resections were performed in 69 patients who had undergone a previous resection. The mean interval between the first and second resection was 2.4 +/- 2.5 years. Seventy-three percent of patients presented with stage I cancers, 9% with stage II cancers, and 17% with stage III cancers. Lobectomy and wedge resection were performed with equal frequency (42% each) for the metachronous cancers. Operative mortality for the second resection was 5.8%. The mean follow-up after the second resection was 37 months. Overall 5-year actuarial survival for the entire group after the second resection was 33.4%.


CONCLUSIONS
Operations for metachronous cancers provided survival that approximated the expected survival for lung cancer. Surgical intervention should be considered as a safe and effective treatment for resectable metachronous lung cancer in patients with adequate physiologic pulmonary reserve.
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, 3108 Queeny Tower, St. Louis, MO 63110, USA. battafarano@msnotes.wustl.edu
Richard J
RJ
Battafarano
Seth D
SD
Force
Bryan F
BF
Meyers
Jennifer
J
Bell
Tracey J
TJ
Guthrie
Joel D
JD
Cooper
G Alexander
GA
Patterson
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D016609:Neoplasms, Second Primary / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011013:Pneumonectomy; D012086:Reoperation; D015656:Respiratory Mechanics; D015996:Survival Rate