Cardiothoracic Surgery |

Successful Treatment of Synchronous Primary Carcinomas of the Lungs: One Primary in Each Lung FREE TO VIEW

Geoffrey Graeber, MD; Syed Quadri, MD; Karl Uy, MD
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Univ of Massachusetts Medical School, Worcester, MA, MA

Chest. 2014;145(3_MeetingAbstracts):43A. doi:10.1378/chest.1836524
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SESSION TITLE: Thoracic Surgery Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: To delineate a successful approach to treating synchronous primary lung cancers arising simultaneously with one primary in each lung. The primary which appears to be more advanced clinically is resected first. The second is resected as soon as possible after the patient has rcovered adequately from the first procedure.

METHODS: A 76 year old woman who was being followed for successfully treated breast cancer was found to have two new nodules in her lungs on routine CT of the chest. The larger nodule in the superior segment of the lower lobe of the right lung proved to be squamous cell carcinoma of pulmonary origin on needle biopsy. The smaller nodule located in the superior segment of the left lung was adenocarcinoma of pulmonary origin on needle biopsy. The patient's comorbidities included COPD secondary to smoking, hypertension, and coronary artery disease. The patient was prepared for limited sequential resections of the primaries due to her compromised pulmonary reserve.

RESULTS: A Video-assisted right superior segmentectomy was attempted in August,2010, but had to be converted to an open procedure since the patient could not tolerate having the right lung collapsed. A successful R0 resection of the superior segment was achieved without complications. Based on the experience gained from this resection, an open superior segmentectomy conducted through a limited thoracotomy achieved an R0 resection of the lesion in the lower lobe of the left lung in November, 2010. Pathologic examination confirmed that both lesions were Stage IA (T1N0M0) primary lung cancers of the types diagnosed earlier by needle biopsies. Sequential CT scans have denoted no recurrences.

CONCLUSIONS: 1.) Synchronous primary lung cancers can be resected successfully using sequential limited incisions and resections even in patients with respiratory compromise. 2.) The lesion which is more clinically advanced should be treated first. 3.) Preoperative confirmation of the pathologic nature of both lesion should be conducted p to direct appropriate therapy.

CLINICAL IMPLICATIONS: Patients who have compromised pulmonary function can have more than one lung primary resected with good clinical outcome.

DISCLOSURE: The following authors have nothing to disclose: Geoffrey Graeber, Syed Quadri, Karl Uy

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