Original article
General thoracic
Single-Stage Surgical Treatment of Synchronous Bilateral Multiple Lung Cancers

https://doi.org/10.1016/j.athoracsur.2006.10.037Get rights and content

Background

The rate of detection of synchronous bilateral multiple lung cancers (SBMLC) has increased. We evaluated applicability and efficacy of single-stage surgical treatment of SBMLC patients encountered in our department.

Methods

In a retrospective examination of 674 patients who underwent surgical treatment of primary lung cancers at our department between 1999 and 2004, single-stage surgical treatment was used in 19 patients. Clinical and histologic features, approaches, and outcomes of surgical treatments were studied retrospectively.

Results

The 19 patients (6 men, 13 women) were a median age of 65.8 years (range, 52 to 80 years). At operation, all 11 patients (58%) were women with no history of smoking. Lobectomy and wedge resection on the opposite side were performed in 13 patients, segmentectomy and wedge resection were performed in 1, and bilateral wedge resection was done in 5. Postoperative histopathologic examination revealed that 84 lesions were adenocarcinomas and three were squamous cell carcinomas. All pure ground glass opacities (GGOs) measuring less than 10 mm in diameter on high-resolution computed tomography imaging were diagnosed as bronchioloalveolar carcinoma (BAC) type A or B. No patients died perioperatively. The median postoperative observation period was 44 months. Overall survival rates were 94.7% at 3 years and 75.8% at 5 years. In cases of multifocal BAC after resection, development of new lesions was observed in 4 patients.

Conclusions

Single-stage bilateral surgical treatment of SBMLC yielded satisfactory results in our selected patients; however, appearance of new lesions remains a problem.

Section snippets

Patients and Methods

The Toranomon Hospital Institutional Review Board of Clinical Research approved this study, and the need for informed consent from patients was waved because of its retrospective design. From April 1999 to December 2004, 674 patients underwent surgery for primary lung cancer in our department. A retrospective examination of their clinical records indicated that for 22 patients, preoperative CT revealed bilateral multiple lesions (Table 1).

Single-stage bilateral surgical treatment was applied,

Results

During the study period, 19 of 674 patients were shown to have SBMLC, corresponding to 2.8% of all patients who underwent surgical treatments of primary lung cancers at our hospital. Patient characteristics are listed in Table 1. The patients (6 men, 13 women) were a median age of 65.8 years (range, 52 to 80 years). At the time of operation, 8 (42%) of 19 patients (6 men, 2 women) were smokers, and the remaining 11 patients (58%), who were all women, had no history of smoking. Three patients

Comment

The detection rate of synchronous multiple lung tumors has recently increased owing to advances in diagnostic radiographic techniques and the introduction of helical CT in the screening of lung cancers [1, 2, 3]. Prevalence of multiple primary lung cancers remains unclear and varies in the literature from 0.8% to 10.0% for both synchronous and metachronous cancers [8, 9, 10, 11, 12]. For synchronous multiple cancers alone, prevalence varies from 0.3% to 4.6%. In our study, 3.3% of patients who

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