Surgical treatments for multiple primary adenocarcinoma of the lung

Ann Thorac Surg. 2004 Oct;78(4):1194-9. doi: 10.1016/j.athoracsur.2004.03.102.


Background: The aim of this study was to identify the clinical characteristics of multiple primary adenocarcinomas and to evaluate the efficacy of surgical treatments.

Methods: Three-hundred sixty-nine patients who underwent pulmonary resection for adenocarcinoma from January 1994 to December 2002 were reviewed.

Results: Thirty-one patients (8.4%) were determined to have multiple primary adenocarcinomas that could be detected on chest x-rays or computed tomography (CT). Twenty-six patients were synchronous and five patients were metachronous with a median interval of 59.0 months. Forty-nine (72.1%) of the total 68 lesions exhibited ground-glass opacity on high-resolution CT (HRCT). Pathologically well-differentiated adenocarcinoma with mixed bronchioloalveolar pattern was the most common subtype (39.7%). Taking into consideration pulmonary function, size, location, and HRCT findings of the lesions the procedures performed were lobectomy with mediastinal lymph-node dissection for 32 patients, segmentectomy with hilar node dissection for 8 patients, and wedge resection for 28 patients. Of 17 patients with bilateral synchronous cancers, simultaneous bilateral pulmonary resection was performed in 14 patients including simultaneous bilateral video-assisted thoracic surgery (VATS) in 11 patients. After a median follow-up period of 27.7 months, the 3-year overall survival rate was 92.9% and the 3-year disease-free survival rates of synchronous cancer and metachronous cancer were 77.9% and 100%, respectively.

Conclusions: The incidence of multiple primary adenocarcinomas was relatively common. Early radiographic detection and surgical excision could yield a favorable prognosis. The use of VATS, even for synchronous bilateral patients, was a safe and beneficial procedure.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / epidemiology
  • Adenocarcinoma / mortality
  • Adenocarcinoma / surgery*
  • Adenocarcinoma, Bronchiolo-Alveolar / diagnostic imaging
  • Adenocarcinoma, Bronchiolo-Alveolar / epidemiology
  • Adenocarcinoma, Bronchiolo-Alveolar / mortality
  • Adenocarcinoma, Bronchiolo-Alveolar / surgery
  • Aged
  • Carcinoma, Non-Small-Cell Lung / diagnostic imaging
  • Carcinoma, Non-Small-Cell Lung / epidemiology
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Carcinoma, Non-Small-Cell Lung / surgery*
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Life Tables
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / mortality
  • Lung Neoplasms / surgery*
  • Lymph Node Excision
  • Male
  • Middle Aged
  • Neoplasms, Multiple Primary / diagnostic imaging
  • Neoplasms, Multiple Primary / epidemiology
  • Neoplasms, Multiple Primary / mortality
  • Neoplasms, Multiple Primary / surgery*
  • Neoplasms, Second Primary / diagnostic imaging
  • Neoplasms, Second Primary / epidemiology
  • Neoplasms, Second Primary / mortality
  • Neoplasms, Second Primary / surgery*
  • Pneumonectomy / methods*
  • Retrospective Studies
  • Risk Factors
  • Smoking / epidemiology
  • Survival Analysis
  • Survival Rate
  • Thoracic Surgery, Video-Assisted
  • Tomography, Spiral Computed
  • Treatment Outcome