title: Is lobectomy really more effective than sublobar resection in the surgical treatment of second primary lung cancer?
abstract: OBJECTIVE
  Sublobar resection for early-stage lung cancer is still a controversial issue. We sought to compare sublobar resection (segmentectomy or wedge resection) with lobectomy in the treatment of patients with a second primary lung cancer.
  
  
  METHODS
  From January 1995 to December 2010, 121 patients with second primary lung cancer, classified by the criteria proposed by Martini and Melamed, were treated at our Institution. We had 23 patients with a synchronous tumour and 98 with metachronous. As second treatment, we performed 61 lobectomies (17 of these were completion pneumonectomies), 38 atypical resections and 22 segmentectomies. Histology was adenocarcinoma in 49, squamous in 38, bronchoalveolar carcinomas in 14, adenosquamous in 8, large cells in 2, anaplastic in 5 and other histologies in 5.
  
  
  RESULTS
  Overall 5-year survival from second surgery was 42%; overall operative mortality was 2.5% (3 patients), while morbidity was 19% (22 patients). Morbidity was comparable between the lobectomy group, sublobar resection and completion pneumonectomies (12.8, 27.7 and 30.8%, respectively, P = 0.21). Regarding the type of surgery, the lobectomy group showed a better 5-year survival than sublobar resection (57.5 and 36%, respectively, P = 0.016). Compared with lobectomies, completion pneumonectomies showed a significantly less-favourable survival (57.5 and 20%, respectively, P = 0.001).
  
  
  CONCLUSIONS
  From our experience, lobectomy should still be considered as the treatment of choice in the management of second primary lung cancer, but sublobar resection remains a valid option in high-risk patients with limited pulmonary function. Completion pneumonectomy was a negative prognostic factor in long-term survival.
authors: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy. andrea.zuin@unipd.it
authors: Andrea
authors: A
authors: Zuin
authors: Luigi Gaetano
authors: LG
authors: Andriolo
authors: Giuseppe
authors: G
authors: Marulli
authors: Marco
authors: M
authors: Schiavon
authors: Samuele
authors: S
authors: Nicotra
authors: Francesca
authors: F
authors: Calabrese
authors: Paola
authors: P
authors: Romanello
authors: Federico
authors: F
authors: Rea
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Lobectomy; Lung cancer; Multiple primary lung cancer; Sublobar resection