Safety and optimal pattern of second surgery for lung cancer patients with history of lung resection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LIN Gang , LIU Bing , LIU Haibo , LI Jian

Department of Thoracic Surgery, Peking University First Hospital, Beijing, 100034, P.R.China;

Corresponding author：

LIN Gang, Email: Lingang0608@163.com

Keywords：

Lung cancer; postoperative complications; lobectomy; sublobectomy

DOI：

10.7507/1007-4848.201612011

Video：

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Objective To analyze the safety of surgical treatment and optimal surgical procedure for lung cancer patients with prior history of lung resection. Methods The medical records of 69 lung cancer patients with history of lung resection was retrospectively collected. There were 53 males and 16 females with a median age of 68 years ranging from 45 to 80 years. The risk factors for postoperative complications were analyzed using one-way ANOVA and logistic regression analysis. By comparing the data between the lobectomy and sublobectomy groups, the best surgical procedure was chosen. Results The 90-day mortality rate was 4.3%. Postoperative complication rate was 24.6%. Results of one-way ANOVA showed that blood loss during operation (P=0.020), tumor size (P=0.007), smoking (P=0.028) and FEV1%pre (P=0.018) were associated with increased major postoperative complications. Logistic regression analysis showed that FEV1%pre<77.0% (OR=0.935, 95%CI 0.888 to 0.984, P=0.010) and tumor size≥2 cm (OR=4.288, 95%CI 1.375 to 13.373, P=0.012) were independent risk factors for major postoperative complications. Lobectomy and sublobectomy groups had similar postoperative mortality and complication rate (P=0.063). Conclusion Surgical resection for selected lung cancer patients with history of lung resection is safe with low postoperative mortality and complication rate. Lobectomy with lymph node resection is the first choice if cardiopulmonary function permits. Pneumonectomy is not recommended.

Citation： LIN Gang, LIU Bing, LIU Haibo, LI Jian. Safety and optimal pattern of second surgery for lung cancer patients with history of lung resection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(8): 611-616. doi: 10.7507/1007-4848.201612011 Copy

1.	Donington J, Ferguson M, Mazzone P, et al. American college of chest physicians and society of thoracic surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer. CHEST, 2012, 142(6): 1620-1635.
2.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Ann Thorac Surg, 1995, 60(3): 615-623.
3.	Black WC, Keeler EB, Soneji SS, et al. Cost-effectiveness of CT screening in the national lung screening trial. N Engl J Med, 2014, 371(19): 1793-1802.
4.	Jaklitsch MT, Jacobson FL, Austin JH, et al. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg, 2012, 144(1): 33-38.
5.	Johnson BE, Cortazar P, Chute JP. Second lung cancers in patients successfully treated for lung cancer. Semin Oncol, 1997, 24(4): 492-499.
6.	Johnson BE. Second lung cancers in patients after treatment for an initial lung cancer. J Natl Cancer Inst, 1998, 90(18): 1335-1345.
7.	Lou F, Huang J, Sima CS, et al. Patterns of recurrence and second primary lung cancer in early-stage lung cancer survivors followed with routine computed tomography surveillance. J Thorac Cardiovasc Surg, 2013, 145(1): 75-81.
8.	Hamaji M, Allen MS, Cassivi SD, et al. Surgical treatment of metachronous second primary lung cancer after complete resection of non-small cell lung cancer. J Thorac Cardiovasc Surg, 2013, 145(3): 683-690.
9.	Linden PA, Yeap BY, Chang MY, et al. Morbidity of lung resection after prior lobectomy: results from the veterans affairs national surgical quality improvement program. Ann Thorac Surg, 2007, 83(2): 425-432.
10.	Durkin C, Lohser J. Oxygenation and ventilation strategies for patients undergoing lung resection surgery after prior lobectomy or pneumonectomy. Curr Anesthesiol Rep, 2016, 6(2): 135-141.
11.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
12.	Deschamps C, Pairolero PC, Trastek VF, et al. Multiple primary lung cancers: results of surgical treatment. J Thorac Cardiovasc Surg, 1990, 99(5): 769-777.
13.	van Rens MT, Zanen P, de la Riviere AB, et al. Survival after resection of metachronous non-small cell lung cancer in 127 patients. Ann Thorac Surg, 2001, 71(1): 309-313.
14.	Battafarano RJ, Force SD, Meyers BF, et al. Benefits of resection for metachronous lung cancer. J Thorac Cardiovasc Surg, 2004, 127(3): 836-842.
15.	Harpole DH Jr, DeCamp MM Jr, Daley J, et al. Prognostic models of thirty-day mortality and morbidity after major pulmonary resection. J Thorac Cardiovasc Surg, 1999, 117(5): 969-979.
16.	郭法海, 申屠阳. 多原发肺癌的诊断和处理策略新进展. 中国肺癌杂志, 2016, 19(5): 307-311.
17.	Yu YC, Hsu PK, Yeh YC, et al. Surgical results of synchronous multiple primary lung cancers: similar to the stage-matched solitary primary lung cancers? Ann Thorac Surg, 2013, 96(6): 1966-1974.
18.	Zuin A, Andriolo LG, Marulli G, et al. Is lobectomy really more effective than sublobar resection in the surgical treatment of second primary lung cancer? Eur J Cardiothorac Surg, 2013, 44(2): e120-e125.
19.	Yang H, Sun Y, Yao F, et al. Surgical therapy for bilateral multiple primary lung cancer. Ann Thorac Surg, 2015: 101(3): 1145-1152.
20.	Ettinger DS, Wood DE, Akerley W, et al. NCCN Guidelines Insights: Non-Small Cell Lung Cancer, Version 4. 2016. J Natl Compr Canc Netw, 2016, 14(3): 255-264.
21.	王俊, 赵辉. 亚肺叶切除治疗早期肺癌需要考虑的几个问题. 中国肺癌杂志, 2016, 19(6): 351-354.
22.	Rosengart TK, Martini N, Ghosn P, et al. Multiple primary lung carcinomas: prognosis and treatment. Ann Thorac Surg, 1991, 52(4): 773-778.
23.	Aziz TM, Saad RA, Glasser J, et al. The management of second primary lung cancers. A single center experience in 15 years. Eur J Cardiothorac Surg. 2002, 21(3): 527-533.

1. Donington J, Ferguson M, Mazzone P, et al. American college of chest physicians and society of thoracic surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer. CHEST, 2012, 142(6): 1620-1635.
2. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Ann Thorac Surg, 1995, 60(3): 615-623.
3. Black WC, Keeler EB, Soneji SS, et al. Cost-effectiveness of CT screening in the national lung screening trial. N Engl J Med, 2014, 371(19): 1793-1802.
4. Jaklitsch MT, Jacobson FL, Austin JH, et al. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg, 2012, 144(1): 33-38.
5. Johnson BE, Cortazar P, Chute JP. Second lung cancers in patients successfully treated for lung cancer. Semin Oncol, 1997, 24(4): 492-499.
6. Johnson BE. Second lung cancers in patients after treatment for an initial lung cancer. J Natl Cancer Inst, 1998, 90(18): 1335-1345.
7. Lou F, Huang J, Sima CS, et al. Patterns of recurrence and second primary lung cancer in early-stage lung cancer survivors followed with routine computed tomography surveillance. J Thorac Cardiovasc Surg, 2013, 145(1): 75-81.
8. Hamaji M, Allen MS, Cassivi SD, et al. Surgical treatment of metachronous second primary lung cancer after complete resection of non-small cell lung cancer. J Thorac Cardiovasc Surg, 2013, 145(3): 683-690.
9. Linden PA, Yeap BY, Chang MY, et al. Morbidity of lung resection after prior lobectomy: results from the veterans affairs national surgical quality improvement program. Ann Thorac Surg, 2007, 83(2): 425-432.
10. Durkin C, Lohser J. Oxygenation and ventilation strategies for patients undergoing lung resection surgery after prior lobectomy or pneumonectomy. Curr Anesthesiol Rep, 2016, 6(2): 135-141.
11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
12. Deschamps C, Pairolero PC, Trastek VF, et al. Multiple primary lung cancers: results of surgical treatment. J Thorac Cardiovasc Surg, 1990, 99(5): 769-777.
13. van Rens MT, Zanen P, de la Riviere AB, et al. Survival after resection of metachronous non-small cell lung cancer in 127 patients. Ann Thorac Surg, 2001, 71(1): 309-313.
14. Battafarano RJ, Force SD, Meyers BF, et al. Benefits of resection for metachronous lung cancer. J Thorac Cardiovasc Surg, 2004, 127(3): 836-842.
15. Harpole DH Jr, DeCamp MM Jr, Daley J, et al. Prognostic models of thirty-day mortality and morbidity after major pulmonary resection. J Thorac Cardiovasc Surg, 1999, 117(5): 969-979.
16. 郭法海, 申屠阳. 多原发肺癌的诊断和处理策略新进展. 中国肺癌杂志, 2016, 19(5): 307-311.
17. Yu YC, Hsu PK, Yeh YC, et al. Surgical results of synchronous multiple primary lung cancers: similar to the stage-matched solitary primary lung cancers? Ann Thorac Surg, 2013, 96(6): 1966-1974.
18. Zuin A, Andriolo LG, Marulli G, et al. Is lobectomy really more effective than sublobar resection in the surgical treatment of second primary lung cancer? Eur J Cardiothorac Surg, 2013, 44(2): e120-e125.
19. Yang H, Sun Y, Yao F, et al. Surgical therapy for bilateral multiple primary lung cancer. Ann Thorac Surg, 2015: 101(3): 1145-1152.
20. Ettinger DS, Wood DE, Akerley W, et al. NCCN Guidelines Insights: Non-Small Cell Lung Cancer, Version 4. 2016. J Natl Compr Canc Netw, 2016, 14(3): 255-264.
21. 王俊, 赵辉. 亚肺叶切除治疗早期肺癌需要考虑的几个问题. 中国肺癌杂志, 2016, 19(6): 351-354.
22. Rosengart TK, Martini N, Ghosn P, et al. Multiple primary lung carcinomas: prognosis and treatment. Ann Thorac Surg, 1991, 52(4): 773-778.
23. Aziz TM, Saad RA, Glasser J, et al. The management of second primary lung cancers. A single center experience in 15 years. Eur J Cardiothorac Surg. 2002, 21(3): 527-533.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Safety and optimal pattern of second surgery for lung cancer patients with history of lung resection

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