Surgical Treatments for Multiple Primary Adenocarcinoma of the Lung

• Published in: The Annals of thoracic surgery Vol. 78; no. 4; pp. 1194 - 1199
• Main Authors: Nakata, Masao, Sawada, Shigeki, Yamashita, Motohiro, Saeki, Hideyuki, Kurita, Akira, Takashima, Shigemitsu, Tanemoto, Kazuo
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2004; Elsevier Science
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - epidemiology; Adenocarcinoma - mortality; Adenocarcinoma - surgery; Adenocarcinoma, Bronchiolo-Alveolar - diagnostic imaging; Adenocarcinoma, Bronchiolo-Alveolar - epidemiology; Adenocarcinoma, Bronchiolo-Alveolar - mortality; Adenocarcinoma, Bronchiolo-Alveolar - surgery; Aged; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - epidemiology; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - surgery; Disease-Free Survival; Female; Follow-Up Studies; Humans; Incidence; Life Tables; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - epidemiology; Lung Neoplasms - mortality; Lung Neoplasms - surgery; Lymph Node Excision; Male; Medical sciences; Middle Aged; Neoplasms, Multiple Primary - diagnostic imaging; Neoplasms, Multiple Primary - epidemiology; Neoplasms, Multiple Primary - mortality; Neoplasms, Multiple Primary - surgery; Neoplasms, Second Primary - diagnostic imaging; Neoplasms, Second Primary - epidemiology; Neoplasms, Second Primary - mortality; Neoplasms, Second Primary - surgery; Pneumology; Pneumonectomy - methods; Retrospective Studies; Risk Factors; Smoking - epidemiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgery of the respiratory system; Survival Analysis; Survival Rate; Thoracic Surgery, Video-Assisted; Tomography, Spiral Computed; Treatment Outcome; Tumors of the respiratory system and mediastinum; 10; Lung disease; Multiple; Treatment; Respiratory disease; Surgery; Lung cancer; Primary; Bronchus disease; Thorax; Malignant tumor; Bronchopulmonary adenocarcinoma
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2004.03.102

The aim of this study was to identify the clinical characteristics of multiple primary adenocarcinomas and to evaluate the efficacy of surgical treatments. Three-hundred sixty-nine patients who underwent pulmonary resection for adenocarcinoma from January 1994 to December 2002 were reviewed. 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. 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.