Resection for second and third primary lung cancer.

The continued increasing incidence of bronchogenic carcinoma increases the likelihood that a patient may develop a second or third primary tumor. We have carried out a second thoracotomy for 114 patients who met our criteria of having a new primary lung cancer. These criteria were a different histologic cell type, a tumor-free interval of 24 mo, the second primary in the contralateral lung, or the new tumor in a separate and distinct ipsilateral lobe if the tumor was on the same side. There were 18 patients who had a thoracotomy for a third primary lung cancer and they met the same criteria. There were 73 segmental resections in the 132 thoracotomies, and a conservative resection is important to minimize postoperative complications. Operative mortality for the second resection group of patients was 8.8% (10/114). There was one operative death in the 18 patients undergoing a third resection. The cumulative survival rate following a second resection in 114 patients with metachronous tumors was 33% at 5 yr and 20% at 10 yr. Early detection of a second and third primary lung cancer and surgical resection offers the greatest chance for long-term survival in this group of patients.