Surgical Treatment of Multiple Primary Adenocarcinomas of the Lung

 

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Abstract

Introduction: The incidence of lung adenocarcinomas has steadily increased over the last decades. The aim of this study was to assess the results of surgical treatment of multiple primary adenocarcinomas of the lung (MPAL) analyzing the radiological and histological features. Methods: From 1988 to 2005, 26 patients underwent surgical treatment for MPAL at our department, for a total of 52 tumors. Three patients had synchronous and 23 had metachronous tumors. Results: Thirty-seven tumors were classified as solid, two as ground-glass opacities (GGO) and 13 as mixed solid/GGO tumors on the basis of CT scan evaluation. Histology revealed 26 adenocarcinomas, five adenocarcinomas with a bronchioloalveolar (BAC) pattern and 21 BAC. There was no postoperative mortality. Five-year survival of patients with synchronous tumors was 66 %. Survival of patients with metachronous tumors was 95 % and 70 % from the first and second operation. Patients with stage II and III a tumors had significantly reduced survival rates (p < 0.05). Survival was 60 % after lobectomy and 78 % after wedge resection. Conclusions: Surgical treatment of MPAL is associated with favorable results. Sublobar resections, when technically feasible, provide adequate oncological management.

References

• 1 Charloux A, Quoix E, Wolkove N, Small D, Pauli G, Kreisman H. The increasing incidence of lung adenocarcinoma: reality or artefact? A review of the epidemiology of lung adenocarcinoma.  Int J Epidemiol. 1997;  26 14-23
  CrossrefPubMedGoogle Scholar
• 2 Travis W D, Garg K, Franklin W A. et al . Bronchioloalveolar carcinoma and lung adenocarcinoma: the clinical importance and research relevance of 2004 World Health Organization pathologic criteria.  J Thorac Oncol. 2006;  1 S13-S19
  CrossrefPubMedGoogle Scholar
• 3 Sone S, Takashima S, Li F, Yang Z. et al . Mass screening for lung cancer with mobile spiral computed tomography scanner.  Lancet. 1998;  351 1242-1245
  CrossrefPubMedGoogle Scholar
• 4 Fukui T, Sakakura N, Mori S. et al . Controversy about small peripheral lung adenocarcinomas: how should we manage them?.  J Thorac Oncol. 2007;  2 (6) 546-552
  CrossrefPubMedGoogle Scholar
• 5 Rea F, Zuin A, Callegaro D, Bortolotti L, Guanella G, Sartori F. Surgical results for multiple primary lung cancers.  Eur J Cardiothorac Surg. 2001;  20 489-495
  CrossrefPubMedGoogle Scholar
• 6 Roberts P F, Straznika M, Lara P N. et al . Resection of multifocal non-small cell lung cancer when the bronchioloalveolar subtype is involved.  J Thorac Cardiovasc Surg. 2003;  126 1597-1602
  CrossrefPubMedGoogle Scholar
• 7 Martini N, Melamed M R. Multiple primary lung cancers.  J Thorac Cardiovasc Surg. 1975;  70 606-612
  CrossrefPubMedGoogle Scholar
• 8 Rush V W, Tsuchiya R, Tsuboi M, Pass H I, Grunenwald D, Goldstraw P. Surgery for bronchioloalveolar carcinoma and ‘very early’ adenocarcinoma: an evolving standard of care?.  J Thorac Oncol. 2006;  1 S27-S31
  CrossrefPubMedGoogle Scholar
• 9 Kitamura H, Kameda Y, Ito T, Hayashi H. Atypical adenomatous hyperplasia of the lung. Implications for the pathogenesis of peripheral lung adenocarcinoma.  Am J Clin Pathol. 1999;  111 610-622
  PubMedGoogle Scholar
• 10 Yatabe Y, Kosaka T, Takahashi T, Mitsudomi T. EGFR mutation is specific for terminal respiratory unit type adenocarcinoma.  Am J Surg Pathol. 2005;  29 633-639
  CrossrefPubMedGoogle Scholar
• 11 Battafarano R J, Meyers B F, Guthrie T J, Cooper J D, Patterson G A. Surgical resection of multi-focal non-small cell lung cancer is associated with prolonged survival.  Ann Thorac Surg. 2002;  74 988-994
  CrossrefPubMedGoogle Scholar
• 12 Lung Cancer Study Group . Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer.  Ann Thorac Surg. 1995;  60 615-623
  CrossrefPubMedGoogle Scholar
• 13 Nakata M, Sawada S, Yamashita M. et al . Surgical treatments for multiple primary adenocarcinoma of the lung.  Ann Thorac Surg. 2004;  78 1194-1199
  CrossrefPubMedGoogle Scholar
• 14 Miller D L, Rowland C M, Deschamps C, Allen M S, Trastek V F, Pairolero P C. Surgical treatment of non-small cell lung cancer 1 cm or less in diameter.  Ann Thorac Surg. 2002;  73 1545-1551
  CrossrefPubMedGoogle Scholar
• 15 Ikeda N, Maeda J, Yashima K. et al . A clinicopathologic study of resected adenocarcinoma 2 cm or less in diameter.  Ann Thorac Surg. 2004;  78 1011-1016
  CrossrefPubMedGoogle Scholar
• 16 Okada M, Nishio W, Sakamoto T. et al . Effect of tumor size on prognosis in patients with non-small cell lung cancer: the role of segmentectomy as a type of lesser resection.  J Thorac Cardiovasc Surg. 2005;  129 87-93
  CrossrefPubMedGoogle Scholar
• 17 Nakamura H, Saji H, Ogata A, Saijo T, Okada S, Kato H. Lung cancer patients showing pure ground-glass opacity on computed tomography are good candidates for wedge resection.  Lung Cancer. 2004;  44 61-68
  CrossrefPubMedGoogle Scholar
• 18 Noguchi M, Morikawa A, Kawasaki M. et al . Small adenocarcinoma of the lung. Histologic characteristics and prognosis.  Cancer. 1995;  75 2844-2852
  CrossrefPubMedGoogle Scholar
• 19 Takashima S, Li F, Maruyama Y. et al . Discrimination of subtypes of small adenocarcinoma in the lung with thin-section CT.  Lung Cancer. 2002;  36 175-182
  CrossrefPubMedGoogle Scholar
• 20 Kodama K, Higashiyama M, Yokouchi H. et al . Prognostic value of ground-glass opacity found in small cell adenocarcinoma on high-resolution CT scanning.  Lung Cancer. 2001;  33 17-25
  CrossrefPubMedGoogle Scholar
• 21 Tsunezuka Y, Shimizu Y, Tanaka N, Takayanagi T, Kawano M. Positron emission tomography in relation to Noguchi's classification for diagnosis of peripheral non-small-cell lung cancer 2 cm or less in size.  World J Surg. 2007;  31 314-317
  CrossrefPubMedGoogle Scholar
• 22 Nomori H, Kosaka N, Watanabe K. et al . 11C-acetate positron emission tomography imaging for lung adenocarcinoma 1 to 3 cm in size with ground-glass opacity images on computed tomography.  Ann Thorac Surg. 2005;  80 2020-2025
  CrossrefPubMedGoogle Scholar

Dr. MD Angelo Carretta

San Raffaele Hospital
Department of Thoracic Surgery

Via Olgettina 60

20132 Milan

Italy

Email: angelo.carretta@hsr.it