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Ann Thorac Surg 2004;78:1194-1199
© 2004 The Society of Thoracic Surgeons
a Department of Surgery, National Shikoku Cancer Center, Ehime, Japan
b Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kawasaki Medical School, Okayama, Japan
c Department of Surgery, Sumitomo Besshi Hospital, Ehime, Japan
Accepted for publication March 25, 2004.
* Address reprint requests to Dr Nakata, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kawasaki Medical School, Matsushima 577, Kurashiki, Okayama 701-0192, Japan
mnakata{at}med.kawasaki-m.ac.jp
BACKGROUND: The aim of this study was to identify the clinical characteristics of multiple primary adenocarcinomas and to evaluate the efficacy of surgical treatments.
METHODS: Three-hundred sixty-nine patients who underwent pulmonary resection for adenocarcinoma from January 1994 to December 2002 were reviewed.
RESULTS: Thirty-one patients (8.4%) were determined to have multiple primary adenocarcinomas that could be detected on chest x-rays or computed tomography (CT). Twenty-six patients were synchronous and five patients were metachronous with a median interval of 59.0 months. Forty-nine (72.1%) of the total 68 lesions exhibited ground-glass opacity on high-resolution CT (HRCT). Pathologically well-differentiated adenocarcinoma with mixed bronchioloalveolar pattern was the most common subtype (39.7%). Taking into consideration pulmonary function, size, location, and HRCT findings of the lesions the procedures performed were lobectomy with mediastinal lymph-node dissection for 32 patients, segmentectomy with hilar node dissection for 8 patients, and wedge resection for 28 patients. Of 17 patients with bilateral synchronous cancers, simultaneous bilateral pulmonary resection was performed in 14 patients including simultaneous bilateral video-assisted thoracic surgery (VATS) in 11 patients. After a median follow-up period of 27.7 months, the 3-year overall survival rate was 92.9% and the 3-year disease-free survival rates of synchronous cancer and metachronous cancer were 77.9% and 100%, respectively.
CONCLUSIONS: The incidence of multiple primary adenocarcinomas was relatively common. Early radiographic detection and surgical excision could yield a favorable prognosis. The use of VATS, even for synchronous bilateral patients, was a safe and beneficial procedure.
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