Does the extent of resection affect survival in patients with synchronous multiple primary lung cancers undergoing curative surgery?: Table 1:

Abstract

A best evidence topic was written according to a structured protocol. The question addressed was whether the extent of pulmonary resection affects survival in patients with synchronous multiple primary lung cancers undergoing curative surgery. A total of 724 papers were identified using the reported searches, of which 14 represented the best evidence to answer the clinical question. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. All studies were retrospective. Eight of 14 studies found no difference in terms of median, overall or progression-free survival when a sublobar resection in the form of a wedge resection or segmentectomy was performed for at least one of the synchronous lesions. Two studies demonstrated a negative impact on survival when lobectomy or bilobectomy was not performed for each lesion. Five papers reviewed the role of pneumonectomy in this category of patients and four of them demonstrated that such an extended resection has a significantly negative impact on survival, while, in one study, although pneumonectomy when compared with sublobar resections and photodynamic therapy had decreased long-term survival, this difference did not reach statistical significance. The use of lung-sparing resections (wedge resection or segmentectomy) of at least one lesion (if technically feasible) is advised for patients with synchronous multiple primary lung cancers. Most studies do not demonstrate any differences in immediate or long-term survival with two anatomical resections. Embarking for anatomical lung resections in the form of lobectomies should be done only in those cases where there are no concerns about postoperative pulmonary reserve. The performance of a pneumonectomy should be avoided, especially for bilateral synchronous lesions, unless it is absolutely necessary.

Survival After Wedge Resection Versus Lobectomy for Stage Ia Second Primary NSCLC with Previous Lung Cancer-Directed Surgery

“…This was also con rmed by the ndings of this study. Similarly, other previous studies [1,14,17,18] did not demonstrate a signi cant difference in prognosis with respect to lobectomy versus sublobectomy for the second tumor. The choice of surgery for the second primary tumor is challenging for thoracic surgeons, especially for patients with history of lobectomy or pneumonectomy.…”

“…In clinical practice, the relative location of two primary tumors had an extremely important in uence on the nal selection of surgical procedure. Generally speaking, when two tumor lesions were in the ipsilateral different lobes, lobectomy for the second lesion tended to lead to pneumonectomy, which was a risk factor affecting the prognosis of patients [4,14,18]. This study found that when the two lesions were in the ipsilateral different lobes, wedge resection demonstrated equivalent OS to lobectomy.…”

“…For stage IA SP-NSCLC patients with previous lung cancer-directed surgery, to date, it has not been fully understood whether lobectomy is more conducive to survival than wedge resection. Although several retrospective studies [16][17][18] and a recent SEER-based study [11] have found that lobectomy did not show a signi cant survival advantage over sublobectomy for SPLC patients, these researches still lacked an indepth study on SPLC patients who have undergone radical surgery for primary lung cancer. To better solve this problem and provide references for further clinical research and practice, we carried out this study.…”

Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules

“…An optimal surgical method for SBMPLC is lacking (16)(17)(18). Lobectomy remains first-line treatment for earlystage NSCLC but a single-stage bilateral lobectomy is not recommended due to the severe trauma imparted.…”

Surgical treatment for early stage non-small cell lung cancer

“…Sublobar resections should also be considered in patients with metachronous or synchronous primary lung cancer, especially in patients with prior resections and with poor predicted remnant pulmonary reserve (56,(61)(62)(63)(64)(65)(66)(67)(68)(69). The majority of studies examining the role of sublobar resections in multiple primary lung cancer have not found a difference in survival when compared to lobectomy (62)(63)(64)(65)(66)(67)(68)(69). Some patients with evidence of less aggressive lung cancer, namely minimally invasive adenocarcinoma (MIA) or adenocarcinoma in situ (AIS), may also be candidates for sublobar resections.…”