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J Thorac Cardiovasc Surg 2004;127:633-635
© 2004 The American Association for Thoracic Surgery

Editorial

Metachronous lung cancer: the role of improved postoperative surveillance

Walter J. Scott, MDa,*

a Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pa, USA

Received for publication November 18, 2003; accepted for publication November 24, 2003.

* Address for reprints: Walter J. Scott, MD, Department of Surgical Oncology, Fox Chase Cancer Center, 7701 Burholme Ave, Philadelphia, PA 19111, USA
W_Scott@fccc.edu

The first 300 words of the full text of this article appear below.


See related article on page 836.

 

In this issue of the Journal, Battafarano and colleagues1 report their experience with resection of malignant lung tumors in 69 patients who had previously undergone resection of a malignant lung tumor. On the basis of a retrospective analysis, they found that resection of so-called metachronous lung tumors could be performed in selected patients with an acceptable surgical mortality rate (5.8%) and meaningful long-term survival (5-year survival of 33.4%). The authors note that the 5-year actuarial survival of patients who had metachronous stage I non–small cell lung cancer (NSCLC) resected was significantly longer than that in patients with more advanced metachronous lesions (42% vs 10%, P = .01). Most of the patients underwent anatomic resection of their metachronous lung tumors, but 42% underwent wedge resection, presumably because of limited pulmonary function. No mention was made of how these metachronous tumors were detected, whether through surveillance in otherwise asymptomatic patients or as a result of the evaluation of patients with symptoms or signs of recurrence. Given these findings, this article raises a number of questions about the clinical management of patients with a history of resected lung cancer who present with a new lung mass. Because patients with earlier stage metachronous tumors survived longer, the article also raises questions about the optimum follow-up of patients after potentially curative resection for lung cancer.

The authors point out that one major problem faced by the clinician is the differentiation of metachronous lung cancer from recurrent-metastatic lung cancer. Battafarano and colleagues1 used the criteria proposed by Martini and Melamed2 in 1975 to define a metachronous tumor as a second primary lung cancer (Table 1). Clinicians realize that misclassification of a metachronous tumor as a metastasis rather than a second primary lung cancer and vice versa . . . [Full Text of this Article]


Related Article

Benefits of resection for metachronous lung cancer
Richard J. Battafarano, Seth D. Force, Bryan F. Meyers, Jennifer Bell, Tracey J. Guthrie, Joel D. Cooper, and G. Alexander Patterson
J. Thorac. Cardiovasc. Surg. 2004 127: 836-842. [Abstract] [Full Text] [PDF]





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