Late outcome and perioperative complications for surgery of locally recurrent bronchogenic carcinoma

Aim. Many doubts involve a 2nd surgical approach for local relapse of non small cell lung cancer (NSCLC) since iterative resections represent a well-recognized treatment in second primary lung cancer (SPLC). Methods. The medical reports of patients who underwent surgical resection, between 1988 and 2002, were reviewed. All patients submitted to 2nd operation were examined according to Martini and Melamed criteria to distinguish between local recurrence and second primary lung cancer. Results. Complete resection for NSCLC was performed in 1 386 patients. Nineteen patients were submitted to surgery for local recurrence (17 men and 2 women) and mean age at the time of 1st operation was 61 years (range 41-78 years). The 1st operation consisted of lobectomy in 15 cases, anatomical segmentectomy in 2 and wedge resection in 2. The 2nd pulmonary resection was completion pneumonectomy in 16 cases, completion lobectomy in 2, wedge resection in 1. Major complications occurred in 26% and overall hospital mortality was 5%. Five-year survival after 2nd intervention was 31% and median survival 27 months. Survival was better when the time between 1st resection and cancer relapse was longer than 14 months and when recurrence was intrapulmonary. Conclusion. A new malignant lesion can be operated if it is solitary and intrapulmonary, if accurate staging is negative and if the patient is able to go through 2nd surgery from cardiopulmonary evaluation.