Surgical Treatment of Multiple Primary Adenocarcinomas of the Lung

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.

thoracic surgery - pulmonary - adenocarcinoma - multiple

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
• 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
• 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
• 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
• 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
• 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
• 7 Martini N, Melamed M R. Multiple primary lung cancers.  J Thorac Cardiovasc Surg. 1975;  70 606-612
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 18 Noguchi M, Morikawa A, Kawasaki M. et al . Small adenocarcinoma of the lung. Histologic characteristics and prognosis.  Cancer. 1995;  75 2844-2852
• 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
• 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
• 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
• 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