Surgical Treatment to Bilateral Multiple Primary Lung Cancer Patients

OBJECTIVES Multiple primary lung cancer( MPLC) has increased due to the extensive detection survey and patient's life-prolonging, but the treatment strategy remains disputable. There is no consensus on the surgical treatment strategy, especially for bilateral multiple primary lung cancer (BMPLC) among MPLC. This paper aimed to discuss the surgical strategy in patients with bilateral multiple lung cancer by our experiences of surgical outcomes. METHODS Patients who underwent curative operations for BMPLC based on the Martini-Melamed criterion and oncogene mutation analysis between January 2007 and May 2019 in Ishikawa Prefectural Central Hospital were reviewed retrospectively. RESULTS We studied 53 patients( 26 males and 27 females, from 64~84 years of age) with MPLC, 43 patients with metachronous lesions, and 10 patients with synchronous lesions. The type of resection for the first tumor was lobectomy 35( 66.0%) and segmentectomy or wedge, 18( 34.0%), and for the second tumor was lobectomy 5( 9.4%) and segmentectomy or wedge, 17( 32.1%) respectively. Bilateral lobectomies underwent in four cases. Histologic classification was similar in 62.3% of patients. Overall survival at five years after the second operation was 75.1%, respectively. There was no difference in subgroups of lobectomy and limited resection (wedge or segmentectomy). Respiratory function in four patients performed with bilobectomy is enough before the second surgery( % vital capacity:84~136%, forced expiratory volume in one second:1,490~3,400 ml, DLco:82~151%). There was no postoperative complication, but one patient suffered from low respiratory function and indications for oxygen therapy at 99 days after the second operation. CONCLUSIONS We selected the surgical procedures that preserve much lung tissues for BMPLC. Bilateral lobectomy did not usually perform in most cases. However, bilobectomy was no contraindication for BMPLC if a preoperative respiratory function was enough for the second tumor.