title: Outcomes after surgical management of synchronous bilateral primary lung cancers.
abstract: BACKGROUND
  Distinguishing between synchronous primary lung cancers and metastatic disease in patients with bilateral lung masses is often difficult. The objective of this study is to examine outcomes associated with a strategy of performing staged bilateral resections in patients without N2 disease based on invasive mediastinal staging and without distant metastases.
  
  
  METHODS
  Patients undergoing resections of bilateral synchronous primary lung cancer at our institution between 1997 and 2010 were reviewed. Perioperative complications were graded according to National Cancer Institute guidelines. Survival was estimated using the Kaplan-Meier method and compared using a log-rank test. End points included overall survival, disease-free survival, operative death, cancer recurrence, and postoperative complications.
  
  
  RESULTS
  Resections of bilateral synchronous primary lung cancers were performed in 47 patients. Forty-five patients (96%) had at least a unilateral thoracoscopic approach; 28 (60%) had bilateral thoracoscopic approaches. The median postresection length of stay was 3 days. Thirteen patients (28%) had a postoperative complication; only 3 (6%) were grade 3 or higher. There was 1 perioperative death (2%). Eleven patients received adjuvant therapy; only 3 patients in whom adjuvant therapy was indicated did not receive the recommended treatment. The overall 3-year survival was 35%. Survival of patients whose bilateral tumors had identical histology did not differ from patients whose histology was different (p = 0.57). Three-year disease-free survival was 24%.
  
  
  CONCLUSIONS
  Aggressive surgical treatment of apparent synchronous bilateral primary lung cancer can be performed with low morbidity. Most patients tolerate the bilateral surgeries and adjuvant therapy. Overall survival is sufficiently high to support this aggressive approach.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Asad A
authors.initials: AA
authors.lastname: Shah
authors.forename: Michael E
authors.initials: ME
authors.lastname: Barfield
authors.forename: Chris R
authors.initials: CR
authors.lastname: Kelsey
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
authors.forename: Betty
authors.initials: B
authors.lastname: Tong
authors.forename: David
authors.initials: D
authors.lastname: Harpole
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery*; D013906:Thoracoscopy; D016896:Treatment Outcome