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Surgery for Second Lung Cancers^*

^* From The Oregon Clinic, PC (Drs. Keppel, Handy, Douville, Tsen, and Ott), and the Earle A. Chiles Research Institute (Dr. Asaph), Providence Portland Medical Center, Portland, OR.

Correspondence to: John F. Keppel, MD, FCCP, The Oregon Clinic, PC, 507 N.E. 47th Ave, Portland, OR 97213

Purpose: To evaluate the outcomes of patients surgically treated for their second primary lung cancer.

Method: In a computerized surgical registry of > 800 consecutive patients treated for primary pulmonary carcinoma since 1980, 37 patients presented with a second lung cancer. These patients were analyzed regarding their original treatment, preoperative evaluation, operative procedures, and long-term follow-up.

Results: Three fifths of the patients were female, and 57% were 65 years old at the time of their second operation. One patient originally had two synchronous tumors; another patient had three metachronous neoplasms. The interval between surgeries ranged from 5 to 239 months. In 31 patients, treatment for their original tumor was surgical resection alone. Lobectomy was the most common operation for the original tumor, and 78% were stage I. When the second tumor was diagnosed, 25 patients (68%) were asymptomatic. Eight patients (22%) were current smokers, and 29 patients (78%) were former smokers. The most common operation for the second tumor was a lobectomy. Surgical mortality was 5.4%. Nineteen patients (51%) survived 2 years, and 9 patients (24%) survived 5 years. Eleven patients (30%) were still alive at last follow-up, 3 to 198 months postoperatively, and only 13 patients (34%) had died of their cancer.

Conclusion: Surgical treatment of second primary pulmonary neoplasms can be performed in selected patients with acceptable long-term survival.

Key Words: CT • lung cancer • metachronous lung tumors

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