Second surgery for metachronous primary lung cancer

Abstract

: As curative surgeries for early-stage non-small cell lung cancer (NSCLC) increase and longer postoperative survival becomes possible, metachronous primary lung cancer (MPLC) have become more common in recent years. Lung cancer survivors have a high risk of MPLC for the rest of their lives, so long-term follow-up and close surveillance are needed. MPLC is often detected relatively early by routine surveillance after the initial surgery, and 64.7% to 85.2% of the cases reported to date have been stage I. Operative mortality after resection of MPLC has been reported to be 0% to 13.0%. Operative morbidity has been reported to be 19.7% to 36.2%. The Five-year overall survival from second surgery was recently reported to be 42% to 78.7%. If the new lesion is solitary and cardiopulmonary function is preserved, complete surgical resection should be considered, regardless of the duration of disease-free survival from initial surgery. Lung-sparing surgery such as segmentectomy or wedge resection and lobectomy have been often reported to have comparable outcomes. Sublobar resection would be acceptable depending on the tumor size and location of the tumor. Because residual pulmonary function is the most important factor for decision-making regarding surgical resection of MPLC, lung preservation should be attempted as much as possible at the time of initial surgery.