Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
Division of General Thoracic Surgery, Niigata Prefectural Central Hospital, Niigata, Japan.
Surg Today. 2020 Nov;50(11):1452-1460. doi: 10.1007/s00595-020-02038-y. Epub 2020 Jun 1.
The best surgical approach for second primary lung cancer remains a subject of debate. The purpose of this study was to review the postoperative complications after second surgery for second primary lung cancer and to investigate the outcomes based on these complications.
The clinical data of 105 consecutive patients who underwent pulmonary resection for multiple primary lung cancers between January, 1996 and December, 2017, were reviewed according to the Martini-Melamed criteria.
After the second surgery, low body mass index (BMI) (< 18.5 kg/m) (P = 0.004) and high Charlson comorbidity index (CCI) (P = 0.002) were independent predictors of postoperative complications. Survival analysis revealed the 5-year overall survival rates of 74.5% and 61.4% for patients without postoperative complications and those with postoperative complications (P = 0.044), respectively, but the 5-year cancer-specific survival rates of 82.5% and 80.0% (P = 0.926), respectively. During this period, there were significantly more respiratory-related deaths of patients with complications than of those without complications (P = 0.011).
Surgical intervention is feasible and potentially effective for second primary lung cancer but may not achieve positive perioperative and long-term outcomes for patients with a low BMI or a high CCI. Treatment options should be considered carefully for these patients.
对于第二原发性肺癌，最佳的手术入路仍存在争议。本研究旨在回顾第二原发性肺癌再次手术后的术后并发症，并根据这些并发症探讨其结果。
根据 Martini-Melamed 标准，回顾了 1996 年 1 月至 2017 年 12 月期间连续 105 例因多原发性肺癌行肺切除术的患者的临床资料。
第二次手术后，低体重指数（BMI）（<18.5 kg/m）（P=0.004）和高 Charlson 合并症指数（CCI）（P=0.002）是术后并发症的独立预测因素。生存分析显示，无术后并发症和有术后并发症患者的 5 年总生存率分别为 74.5%和 61.4%（P=0.044），但 5 年癌症特异性生存率分别为 82.5%和 80.0%（P=0.926）。在此期间，有并发症的患者发生与呼吸相关的死亡明显多于无并发症的患者（P=0.011）。
手术干预对第二原发性肺癌是可行且可能有效的，但对于 BMI 较低或 CCI 较高的患者，可能无法获得积极的围手术期和长期结果。对于这些患者，应慎重考虑治疗选择。
