Repeated Anatomical Pulmonary Resection for Second Primary Nonsmall-Cell Lung Cancer: Safety and Short-Term Outcomes.

Background: Repeated anatomical pulmonary resections in second primary nonsmall-cell lung cancer (NSCLC) pose significant challenges due to prior surgery. This study evaluates the feasibility and short-term outcomes of repeated anatomical pulmonary resections for second primary NSCLC.

Method: We retrospectively reviewed all consecutive cases of repeated anatomical pulmonary resections for second primary NSCLC performed in our institution from January 2014 to December 2023.

Results: A total of 55 patients (median age 68 years; interquartile range [IQR]: 61.5-72) underwent repeated anatomical pulmonary resections for second primary NSCLC. Adenocarcinoma predominated in both primary (78.2%) and secondary (76.4%) cases. Video-assisted thoracoscopy (VATS) approach was used in 94.5% and 96.4% for first and repeated resection, respectively (p = 0.647). The extent of pulmonary resection differed between first and repeated resection, with a predominance of lobectomy during first resection (56.4%) and segmentectomy during repeated resection (85.5%, p < 0.001). We did not observe any significant difference in postoperative overall morbidity after first and repeated resection (23.6% vs. 40%, p = 0.065). However, there was an increased incidence of atrial fibrillation (16.4% vs. 0%) and prolonged air leak (> 5 days) after repeated resection (25.5% vs. 5.5%, p = 0.008). The median length of hospital stay was similar after first and repeated resection (5 vs. 5 days, p = 0.089). The three-year overall survival (OS) was 73% after first resection and 87% after repeated resection. Overall disease recurrence rate was not statistically different between first and repeated resection (1.8% vs. 3.6%, p = 0.558).

Conclusion: Our series demonstrated that second primary NSCLC can be safely managed by VATS segmentectomy, yielding favorable short-term survival and low recurrence rates.