Surgical management of lung cancer with multiple lesions: implication of the new recommendations of the 8th edition of the TNM classification for lung cancer

Abstract

The 8 th tumour, node and metastasis (TNM) revision of the staging classification for lung cancer has attempted to clarify the different properties of four distinct clinical presentations: synchronous multiple primary lung cancers; primary tumour with intrapulmonary metastases; pneumonic-type adenocarcinoma and multiple ground glass/lepidic lesions. The respective biological profiles determine different surgical strategies for each category. Accurate preoperative histological confirmation is required to identify synchronous primary tumours which should then be managed as two separate episodes within the confines of patient characteristics. Equally important is the confirmation of intrapulmonary metastasis which indicates a more conservative resection of the smaller lesion. In contrast, pneumonic-type adenocarcinoma may require larger parenchymal resection to achieve anatomical clearance but also symptom relief. Multiple subsolid lesions require a carefully planned strategy of parenchymal sparing and possible observation of less malignant abnormalities. In all the above situations careful clinical, radiological and pathological assessment is imperative to avoid one embarking on inappropriate invasive management. Either when the widespread nature of the disease renders extensive surgery futile or the relative benign or pre-malignant nature of the multiple lesions imply that the risks of surgery outweigh the prognostic benefits.

Surgical treatment to multiple primary lung cancer patients: a systematic review and meta-analysis

“…Researchers believed that synchronous MPLC with ipsilateral sites should apply lung function preserving approaches, i.e. sublobar resection, while avoiding pneumonectomy; and those with contralateral sites should adopt staged operation [4]. Yet no evidence was given in terms of the sequence of resections.…”

“…At present, surgery is considered as the first choice of treatments for MPLC patients [4, 5] as few researches concerning other treatments were reported. Although there were some studies about surgical treatment of MPLC, it remains controversial about the prognosis of these patients and its impacting factors, such as different resection methods [6].…”

Lobectomy Versus Segmentectomy in Patients with Stage T (>2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study

“…For multiple pulmonary nodules, segmentectomy can potentially reduce the loss of lung function even further. Waller et al [31] found that for multiple primary lung cancer types, segmentectomy is recommended, and lung resection should be avoided; segmentectomy can also allow for the ability to perform future lobectomies. Therefore, segmentectomy compared with lobectomy could have more advantages for the retention of lung function in the shortterm.…”

Surgical treatment to multiple primary lung cancer patients: A systematic review and meta-analysis

“…Researchers believed that synchronous MPLC with ipsilateral sites should apply lung function preserving approaches, i.e. sublobar resection, while avoiding pneumonectomy; and those with contralateral sites should adopt staged operation [4].…”