Surgical treatments for multiple primary adenocarcinoma of the lung.
BACKGROUND
The aim of this study was to identify the clinical characteristics of multiple primary adenocarcinomas and to evaluate the efficacy of surgical treatments.


METHODS
Three-hundred sixty-nine patients who underwent pulmonary resection for adenocarcinoma from January 1994 to December 2002 were reviewed.


RESULTS
Thirty-one patients (8.4%) were determined to have multiple primary adenocarcinomas that could be detected on chest x-rays or computed tomography (CT). Twenty-six patients were synchronous and five patients were metachronous with a median interval of 59.0 months. Forty-nine (72.1%) of the total 68 lesions exhibited ground-glass opacity on high-resolution CT (HRCT). Pathologically well-differentiated adenocarcinoma with mixed bronchioloalveolar pattern was the most common subtype (39.7%). Taking into consideration pulmonary function, size, location, and HRCT findings of the lesions the procedures performed were lobectomy with mediastinal lymph-node dissection for 32 patients, segmentectomy with hilar node dissection for 8 patients, and wedge resection for 28 patients. Of 17 patients with bilateral synchronous cancers, simultaneous bilateral pulmonary resection was performed in 14 patients including simultaneous bilateral video-assisted thoracic surgery (VATS) in 11 patients. After a median follow-up period of 27.7 months, the 3-year overall survival rate was 92.9% and the 3-year disease-free survival rates of synchronous cancer and metachronous cancer were 77.9% and 100%, respectively.


CONCLUSIONS
The incidence of multiple primary adenocarcinomas was relatively common. Early radiographic detection and surgical excision could yield a favorable prognosis. The use of VATS, even for synchronous bilateral patients, was a safe and beneficial procedure.
Department of Surgery, National Shikoku Cancer Center, Ehime, Japan. mnakata@med.kawasaki-m.ac.jp
Masao
M
Nakata
Shigeki
S
Sawada
Motohiro
M
Yamashita
Hideyuki
H
Saeki
Akira
A
Kurita
Shigemitsu
S
Takashima
Kazuo
K
Tanemoto
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015993:Life Tables; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016019:Survival Analysis; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome