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

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.