Metachronous ispilateral lung cancer: Reoperate if you can!

Abstract

The standard of care in operable patients with early-stage lung cancer is surgery, consisting of anatomical parenchymal resection with systematic lymph node dissection. However, there is no firm recommendation regarding the strategy to adopt in patients with a second primary (or multiple primary) lung cancer. This clinical scenario of metachronous lung cancer is not uncommon, with a reported incidence from 0.2% to 20% (1–2% per patient per year) at follow-up after a first lung cancer surgery [1, 2], and is more complex to treat because of the association of several parameters: (i) compromised pulmonary function as the result of the first surgery, (ii) technical surgical difficulties of ipsilateral redo surgeries due to pleural adhesions and/or hilar and mediastinal fibrosis, and intraoperative issues of one-lung ventilation in contralateral surgeries, (iii) higher rate of postoperative complications and (iv) equipoise of alternative ablative options (i.e. SBRT: stereotactic radiotherapy, RFA: radiofrequency ablation). In addition, uncertainty about the possible metastatic nature of a lung nodule thought to be a new primary cancer typifies the complexity to determine the best treatment strategy and results in variable modalities proposed to patients depending on consultant specialty [3].