Favorable surgical outcomes for either second primary lung cancer or intrapulmonary metastasis after resection of nonsmall cell lung cancer.

Metachronous lung cancer arising after resection of nonsmall cell lung cancer (NSCLC) is either a second primary lung cancer (SPLC) or intrapulmonary metastasis (IPM) of the initial lung cancer; however, differential diagnosis is difficult. We evaluated the surgical outcomes of metachronous lung cancer in a combined population of patients with SPLC and IPM. A retrospective study of 3534 consecutive patients with resected NSCLC between 1992 and 2016 was conducted at four institutions. A total of 105 patients (66 males; median age, 70 years) who underwent a second pulmonary resection for metachronous lung cancer were included. Most patients (81%) underwent sublobar resection, and there was no 30-day mortality. All metachronous lung cancers were cN0, 5 were pN1-2. The postoperative comprehensive histologic assessment revealed SPLC (n = 77) and IPM (n = 28). The 5-year overall survival rate after the second resection was 70.6% (median follow-up:69.7 months). A multivariable analysis showed that age >70 years at the second resection (p = 0.013), male sex (p = 0.003), lymph node involvement in metachronous cancer (p < 0.001), pathological invasive size of metachronous cancer >15 mm (p < 0.001), and overlapping squamous cell carcinoma (SCCs) histology of the initial and metachronous cancers (p = 0.003) were significant prognostic factors for poor survival after the second resection, whereas histological IPM was not (p = 0.065). Surgery for cN0 metachronous lung cancer is safe and shows good outcomes. There were no statistically significant differences in the SPLC and IPM results. Caution should be exercised when operating on patients with overlapping SCC.

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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.